PHRM 485 Intercultural and global health issues - Poster presentations Spring 2020

Intercultural and Global Health Issues Spring 2020 Poster Presentations

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Table of Contents Topic (Authors)

Page

Access to food (K Leff, A Prichard, M Struewing) ........................................................................................2 Addiction (Y Jia, A Kim, L Lager, S Stringham) ..............................................................................................3 Alternative medicine (S Allberry, N Boose, K Mathew) ...............................................................................4 Chronic illnesses (J Cordill, M Fernandez, W Sun) .......................................................................................5 Climate change (J Han, J Lee, C Michelle) ....................................................................................................6 Epidemics/pandemics (A Hjermstad, A Lam, R Lazareto) ............................................................................7 Housing (D Bingham, S Meyer, T Parker, A Thompson)...............................................................................8 Human trafficking (A Borici, A Reidel, T Stilwell) .........................................................................................9 Immunizations (A Plumer, K Yaeger, S Yoon).............................................................................................10 Infectious diseases (K Amagai, N Loh, M Masters) ....................................................................................11 Mental health (Z Guo, SY Lee, HY Su, T Zhang) ..........................................................................................12 Nutrition (H Lim, J Park, S Williams) ..........................................................................................................13 Obesity (A Alailima, A Martin, S Vithal) .....................................................................................................14 Pollution (I Corum, M Koh, V Varga) ..........................................................................................................15 Rare diseases (A Everly, S James, A Waldbieser) .......................................................................................16 Women’s reproductive health (A Hernandez-Calderon, H Lohmar, C Hamilton, E Park)..........................17 Compiled by Cynthia Koh-Knox Sharp, PharmD, RPh. Clinical Associate Professor, Pharmacy Practice.

Course Instructor. Purdue University College of Pharmacy. West Lafayette, Indiana

Access to Food

Kelsey Leff, Allyson Prichard, and Mitchell Strewing (PharmD) Spring 2020 Background: Is this a global problem?

Food insecurity is a GLOBAL issue that manifests itself in different ways. One big food insecurity problem that is mainly seen in the United States, in urban areas, are food deserts.

Although food deserts exist globally as well, we will focus on food deserts in the US due to more data availability.

Food Insecurity

What are Food Deserts?

According to the Food Empowerment Project, food deserts are “geographic areas where residents’ access to affordable, healthy food options is restricted or nonexistent due to the absence of grocery stores within convenient travelling distance” [3]. There are roughly 2.3 million people in the US who live more than one mile away from a supermarket and do not own a car, and unfortunately the solution isn’t as simple as the public transportation system-most grocery stores are so few that a shopping trip may require multiple buses or trains [3]. This lack of access to food has large implications on health, so we will be exploring what the correlation is and start to think about what healthcare providers should be addressing with their patients when it comes to food security.

What efforts/solutions have been done?

I have been blown away by the amount of creative solutions that rising healthcare professionals have discovered in order to make a difference in their patient’s access to food. These are just a few examples.

- Geisinger Health Fresh Food Farmacy provides a “prescription” for fresh food; will receive care management, coaching, and education [1] - Eskenazi Health (Indianapolis, Indiana!) à partners with Meals on Wheels to offer medically tailored meals to seniors being discharged from the hospital; links patients to food pantries [1] - Boston Medical Center ED à screen patients for food insecurity; provides a written prescription for free groceries to be picked up at the on-site Preventative Food Pantry; feeds 7,000-8,000 patients each month. [1] Screening for food insecurity is a practice that should be implemented in healthcare procedures. Although we are just starting to find tangible solutions, knowing the nutritional state of your patient will help you make more informed decisions when prescribing medication and taking steps in treatment.

Who/What is affected by this issue?

Food deserts are known to affect areas that are home to ethnic minority and low-income populations [10]. Long term health consequences of having access to healthy food is a large concern. Minority groups tend to have higher rates of obesity, type 2 diabetes, cardiovascular disease, and other diet-related conditions [3]– this cannot conclusively be solely linked to food deserts. Food insecurity is also associated with higher risks of being hospitalized, poorer general health, depression, and suicide ideation [4].

Allyson’s Opinion: I have been very passionate about learning more about food deserts and what we can do to help since I was a senior year in high school. Unfortunately, the older I get and the more I know, the more complicated the situation becomes. I am blown away by the steps certain hospitals and other medical centers have taken in order to care for their patients who are food insecure. In my opinion, this is a very underdeveloped area of our healthcare system - caring for those who are in unavoidable circumstances - and we should be working towards developing more options to help patients who are food insecure.

Production & Processing Background: What is production and processing?

Who is affected by this issue?

Production is the cultivation of crops and the growing Everyone is affected by production and processing. Unless livestock. Processing is the transformation of agricultural you have a home garden, can slaughter you own animals, and products to be edible or more complex. In most cases, can process those raw materials, you are dependent, at least these words are synonymous. Production occurs around in part, by your local supermarket having a constant supply the world and on average the larger the country, the of common goods. The people who are experiencing food greater net production they will have (i.e China, India, insecurity are commonly malnourished. Some forms of United States, etc.). The U.S. is generally malnutrition are partly due to the nutritional value of the self-sustainable, however every country relies on one agricultural product not being a top goal of the producer. [7] another for imports and exports that drive their economy.

Introduction What is access to food and why is it important?

According to the United States Department of Agriculture (USDA), in 2018 “37.2 million people lived in food-insecure households [9].” That means that around 11% of people living in the US do not have reliable access to food. However, insufficient access to food is “not just a national problem, it affects people all over the world. Food insecurity is frequently described as not knowing when the next meal will come.” For some people, that means that their access to food is so poor that they might go an entire day without eating. For others, that could mean that there is not enough money to have breakfast but lunch and dinner are usually available. Access to food that provides adequate nutrition is incredibly important for maintaining health and wellbeing.

Are we producing high quality, nutritious food?

Essentially, some of the food produced today is not as nutrient dense as before. Granted, beyond nutrient content of food, important factors to agriculture are: water/ soil quality, avoiding health hazards, and seasonality of products. When you mess with one variable, it can affect another. Some GMO alternatives to traditional products increase the nutrient density of foods and make them net better calories for people. [6]

Is our global climate capable of increasing production at the rate our population is growing?

The short answer is no. While farming is growing natural products, it is not actually safe for the environment. The best way to increase the “environmental friendliness” of production is through technology. Microsoft is teaming up with The Yield to use Microsoft’s advanced Artificial Intelligence technology to reduce waste and produce more food by helping farmers make the right decisions. Bowery Farming has another solution, vertical farming, which can be done in urban settings and is also very high tech, producing 100x the food in the same footprint using 95% less water.

How safe is our food?

Recalls are a continual threat to access to food. Contaminated food poses a serious danger to Americans’ health, from Tyson's chicken containing metal to E. coli on romaine lettuce. Food recalls are on the rise due to many factors, but the biggest being aging factories, cost cutting, and poor inspections of equipment. To get these numbers back under control the FDA must improve the efficiency of their inspections .

COVID-19 and Supply Chain Continual reports indicate that the U.S. supply chain will remain intact despite the increased demand caused by fear of the coronavirus. This is thanks to decreased demand from sit-in restaurants and ample inventory of non-perishables in warehouses. All in all, with the foreseeable stock of food safe, one thing that we might not be prepared for is the workers who supply the world's food are beginning to get sick. Preceding the pandemic there was already a shortage of workers in agriculture, now it is only going to get worse. This will indeed decrease production of plants, farms, and factories that have less workers. [8] For example, strawberries are still hand planted, weeded, and picked. Now there will be less available.

Mitchell’s Opinion: The United States, and much of the world, is on track to produce and process enough food, even amid a global pandemic. It is only with continued efforts to combat food insecurity, such as using food programs, that we can see an improvement of access to food for lower income and minority individuals. With continuous scientific and technological breakthroughs, producers will successfully serve the global community of tomorrow.

Food Programs What are Food Programs?

Food programs are created to help those who have food insecurity or trouble accessing food. Some of the largest ones are created and sustained by governments. Most programs are delegated to a specific subset of a population such as students or those living in poverty.

Are food programs used worldwide?

Unfortunately access to food is a global issue. Every country has a different view on food programs and who is in need of assistance. The United States has a program called the National School Lunch Program that provides free or reduced lunch to students. On the other hand, Canada does not have a food program for students [5].

Who is affected by food programs?

There are many different populations that are included in food programs. However, most food programs focus on those who live in poverty. Young students in public schools are also a focus of government food programs. The one thing all of these populations have in common is food insecurity.

What has the United States done to fight against food insecurity?

The United States government has created multiple different food programs. The two largest food programs are the National School Lunch Program and the Supplemental Nutrition Assistance Program (which was formerly known as food stamps).

National School Lunch Program This program was originally formed in 1946 because of the large number of men turned away from the Army in World War 2 because of poor nutritional health [2]. In 2009, around 94% of public and private schools in the US participated in the NSLP [2].

There are 2 subsections of the NSLP, free or reduced lunch. Eligibility for eather parts of the program is based on the household’s annual income. In order to receive free lunch, the income must be at or below 130% of the poverty level which is about $1,400 a month [2]. In order to receive reduced lunch, the family household income must be between 130-185% of the poverty level [2].

While the eligibility is explicitly written, there is much more leeway in becoming eligible compared to other food programs in the United States.

Supplemental Nutrition Assistance Program (SNAP) This program is for the general public in need of extra resources in order to afford food. It used to be known as the food stamp program. There are very strict requirements for eligibility for this program.

The first requirement is having a gross monthly income at or below 130% of the poverty level, which is around $1,400 a month [9]. Another requirement for this program is that anybody that you must have a job in order to be eligible for SNAP [9]. There are some subsets of the population (i.e. children and the elderly) who this does not pertain to.

Another requirement for eligibility is documentation.

You are not eligible for SNAP unless you are a documented citizen of the United States [9].

What is food insecurity and how does it relate to access to food?

Food insecurity is the state of being without reliable access to a sufficient quantity of affordable, nutritious food. In short, it is the literal lack of access to food and according to the AAMC, “Food insecurity affects more than 12.7% of US households, roughly 15.8 million people” [1]. Food insecurity can be manifested in many different ways, but the main area we are focusing on is food deserts. Food deserts are a form of food insecurity, specifically relating to a geographic area and a radius of food insecurity.

What does production have to do with access to food?

Before the consumer is able to purchase food in most forms (i.e everything except gardening at your own home) it must first be produced and processed. A fault here creates a domino effect for everyone down the line. Production and processing is the first step for local grocery stores, supermarkets, and food pantries to have the products for consumers to purchase.

How have we tried to fight food insecurity?

The United States has created many programs to deal with food insecurity. Two of the largest food programs are The National School Lunch Program (NSLP) and the Supplemental Nutrition Assistance Program (SNAP). The NSLP is focused on providing free or reduced lunch to students that are in need.

SNAP was created to help combat food insecurity in the general population. There are many requirements to become eligible for both of these food programs. They each include the requirement of earning less than 130% of the poverty level which works out to be around $1,400 a month. While these programs are very helpful, there is still a lot to be done to help the 37.2 million people in the US suffering from food insecurity.

Kelsey’s Opinion: National food programs are a great way to help those living with food insecurity get the food that they need. However, the requirements for eligibility in any of the US food programs are incredibly strict. There are many people living in the United States who are suffering from food insecurity. Undocumented immigrants in the United States do not have very many options if they have food insecurity because they are not able to enroll in any national programs. In order to best combat food insecurity in the US, the public needs to be educated about how rampant it is here. The opinion that food insecurity is only a “3rd world” problem is horribly incorrect, but it is a widespread one. They only way that the national food programs will get better is if the public steps up and helps to change them.

Food insecurity is a global problem, but it is a national one too.

References 1. Driving innovative health care solutions for underserved populations. AAMC. https://www.aamc.org/news-insights/driving-innovative-health-care-solutions-underserved-populations. Published July 10, 2019. Accessed February 13, 2020.

2. Evans, Landon W., "The effect of Free and Reduced Lunch on Reading and Math Achievement" (2015). eses, Dissertations and Capstones. Paper 948.

3. Food Deserts*. Food Empowerment Project. https://foodispower.org/access-health/food-deserts/. Published 2020.

Accessed February 13, 2020.

4. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff. 2015;34(11):1830-1839. https://search.proquest.com/docview/1731536048?accountid=13360. doi: http://dx.doi.org/10.1377/hlthaff.2015.0645.

5. Harper C, Mitchell C, Wood L. The Provision of School Food in 18 Countries. ResearchGate. https://www.researchgate.net/publication/265032327_The_provision_of_school_food_in_18_countries. Published January 1, 2008. Accessed February 25, 2020.

6. Jones AD, Ejeta G. A new global agenda for nutrition and health: the importance of agriculture and food systems.

World Health Organization. https://www.who.int/bulletin/volumes/94/3/15-164509/en/. Published April 16, 2018.

Accessed February 13, 2020.

7. Keding GB, Schneider K, Jordan I. Production and processing of foods as core aspects of nutrition-sensitive agriculture and sustainable diets. SpringerLink. https://link.springer.com/article/10.1007/s12571-013-0312-6.

Published November 26, 2013. Accessed February 13, 2020.

8. Mulvany L, Shanker D, Almeida I. The Workers Who Supply the World’s Food Are Starting to Get Sick.

Bloomberg.com. https://www.bloomberg.com/news/articles/2020-03-27/food-workers-getting-sick-is-the-latest-threat-to-world-supply.

Accessed March 28, 2020.

9. Tiehen L. Supplemental Nutrition Assistance Program (SNAP). USDA ERS - Supplemental Nutrition Assistance Program (SNAP). https://www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutrition-assistance-program-snap/. Accessed February 25, 2020.

10. Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: A review of food deserts literature. Health & Place. https://www.sciencedirect.com/science/article/pii/S1353829210000584. Published April 24, 2010. Accessed February 13, 2020.

Intercultural and Global Health: Addiction Yizhen Jia, BSPS; Spencer Stringham, BSPS; Lucas Lager, BSPS; Andrew Kim, BSPS Spring 2020 Purdue University Introduction Addiction is a mental disease where someone is having a physical or psychological dependence on a substance or a behavior. This usually comes at the expense of themselves and the people around them. According to the National Survey on Drug use and Health 19.7 million people in the United States over the age of 12 suffered from a substance use disorder. [1] With this understanding, the goal of our project is to identify four key sub-issues of addiction that’s specific to alcohol and drugs: Environmental Factors, Age, Mental Health Issues, and Family History.

Addiction Sub-Issues Environmental Factors

Age

Mental Health Issues

• Environmental factors can mean a wide variety of factors. Some specific factors that were investigated are peer pressure and social media influence. This section was restricted to the United States and has a big effect on adolescents/young adults.

• A group of students were surveyed in New Zealand because they had no prior history of ill conduct. It showed no signs that early exposure of drugs influenced their ability to finish school. However, these students were more likely to develop substance issues, test positive for herpes, early pregnancy, and become involved in criminal activity. This shows that adolescents who use these substances are at greater risk than adolescents have don’t use these substances. [8]

• Data shows that there are high rates of mental disorders with the cooccurring use of addictive substances. [11] Some examples of these mental disorders are ADHD, depression, Schizophrenia. The below chart shows that people with Serious Mental Illness (SMI) are much more likely to use drugs then people with Substance Use Disorder (SUD). (Figure 4). This issue can also be related back to age: age group 10-19 is shown to be more susceptible to drug addiction of all age groups afflicted with mental health issues. This means it’s important to seek out adolescents who might be afflicted with a mental health issue. [12]

• From a scientific perspective, the Pre-Frontal Cortex has not been fully developed in adolescent brains. This leads to less cortical inhibition, which is associated with problem solving in adults.

Adolescents are also more susceptible to reward based decision making, this can refer to drug use and the positive feeling associated with it. [9]

• This issue can be perceived as a global issue because mental illnesses aren’t only perceived in one area of the world. Some countries have higher rates of mental illness than other countries. How countries deal with this problem can depend on a countries resources and ability to handle mental health patients and the laws surrounding this area.

• In a study done at the university of North Carolina, there was an experiment done on random college students to test the effects of peer pressure on development of binge drinking. The study found that having a drinking peer increased the episodes of binge drinking in a month by .51 episodes per month. This was only significant for people with a medium propensity for drinking and not those with low or high propensities. [2] • National Center on Addiction and Substance Abuse at Columbia University did a study that showed the correlation between social media use and substance abuse. The survey included responses from 2000 adolescent, the results showed that 70% of the 2000 surveyed are daily users of social media [3], and this number continues to grow. [4] (Figure 1). This group had a positive correlation with increased substance abuse.

Researchers even showed that the biggest reason for using Facebook was that it established social norms. [5] This means that there is a great deal of influence presented by social media. (Figure 2).

• In the United States, there is a campaign by many organizations to prevent peer pressure from drinking and substance abuse. We see all sorts of different websites and organizations giving out helpful advice on avoiding peer pressure. [6] There are also many barriers due to many environmental factors. Research mostly focuses on people afflicted with substance abuse as the biggest barrier to receiving help. However; resources, income, and availability of professionals also takes a toll. In many areas of the country, people afflicted with substance abuse can’t afford to seek professional help or there isn’t a facility close enough for the patient to seek. A big reason for lack of facilities is a lack of funding from the government. Also, researchers concluded that the minimal pay, high stress, long hours of work are barriers for many people aspiring to become counselors. [7]

• This is a huge issue for everyone; because, many people drink under the legal age of drinking. In some countries the legal drinking age is as low as 15, like Ethiopia. [10] Data has shown that people using substances and alcohol have much higher levels of dependence around the ages of below 18, than above 18. (Figure 3).

• The government has implemented programs at multiple levels to try and build a sense of community to help at risk kids. Caring School Community is an example of this in schools that teach kindergarten to 6th grade. [2]

• It’s hard to give a definite solution for this problem because of how many variables are involved. The only way to really help someone struggling with the cooccurrence of using substances and having mental health is recognize the signs. Seek help from medical professionals is the best way to help someone who is self-medicating.

Professional Opinion: Many people choose to self-medicate because of mental illness.

This is a dangerous path to cross because most people who are addicted to dangerous substances or alcohol have some form of mental illness. This means that we need to be educated on the signs of mental illness and help them seek proper help so that they don’t self-medicate. The first step in stopping this issue is recognizing that someone is mentally ill, we can all be a part of the solution in addressing Mental Health Issues.

-A. Kim

Professional Opinion: The younger the user of a substance the more likely he’ll become addicted. There are talks about increasing the drinking age and that could be a solution, but adolescents still find ways to circumvent the law regarding abusive substances and alcohol.

We can all do more as a society by being more vigilant and given out better education to adolescents.

-S. Stringham

Figure 4

Figure 3

Professional Opinion: There are many different variables that comes to play when examining this subtopic, we choose to focus on social media and peer pressure because that also has a correlation with our subtopic, age. There needs to be stricter regulations on social media platforms to promote safe habits. Some methods can be screening posts for adolescent users and people susceptible to drugs and alcohol. As for peer pressure we can only give out more education about the dangers of substance abuse.

- Y. Jia https://www.sciencedirect.com/science/article/pii/S1878929316301931

https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/introduction

Family History • A study shows a positive correlation between having addction when there is a history of addiction within the family. The data provides an example of this by exhibiting that if a person has a firstdegree, alcohol dependent relative, there is a 5-fold increase in the risk for developing alcohol depending. [13] Along with getting the addiction, there is data showing the association between family history and delay discounting for an addiction (Figure 5). Within the study, it is shown that there is a significantly higher rate of delay discounting for those who have two parents with an addiction compared to those with one parent or no parents with addiction. [14]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432862/

Figure 1

Figure 5

• This issue can be shown as a global issue as for anyone, anywhere in the world may have some form of addiction in which the genetic factors that play into this may be passed down to their offspring. The people affected the most would be younger generations due to older generations having less education on the severity of addiction.

• Over the past century, more and more restrictions and education have come about regarding the severity of addiction as well as on how to better lower the risk for addiction. Continuing this education to younger generations while enforcing rules and regulations on addictive substances to have a domino effect on future generations could best help lower the statistics of family history being a risk factor for addiction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715786/

Figure 2

Professional Opinion: Because family history can lead to a significant increase in the risk for addiction, I believe the best thing would be to provide education for younger generations so they can do their best to be preventative in their actions to decrease the continuation of addiction that may run within the family.

-L. Lager

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599355/pdf/nihms897835.pdf

Citations 1. Thomas S. Addiction Statistics: Drug & Substance Abuse Statistics. American Addiction Centers. https://americanaddictioncenters.org/rehab-guide/addiction-statistics. Published February 3, 2020. Accessed March 26, 2020.

2. Guo G, Li Y, Wang H, Cai T, Duncan GJ. Peer Influence, Genetic Propensity, and Binge Drinking: A Natural Experiment and a Replication. AJS. 2015;121(3):914–954. doi:10.1086/683224 3. Hilliard J. The Influence of Social Media on Teen Drug Use - Addiction Center. The Influence of Social Media on Teen Drug Use. https://www.addictioncenter.com/community/social-media-teen-drug-use/. Published October 16, 2019. Accessed March 26, 2020.

4. Moreno MA, Whitehill JM. Influence of Social Media on Alcohol Use in Adolescents and Young Adults. Alcohol Res. 2014;36(1):91–100.

5. Moreno MA, Kota R, Schoohs S, Whitehill JM. The Facebook influence model: a concept mapping approach. Cyberpsychol Behav Soc Netw. 2013;16(7):504–511. doi:10.1089/cyber.2013.0025 6. Caring School Community. Center for the Collaborative Classroom. https://www.collaborativeclassroom.org/programs/caring-school-community/. Accessed March 31, 2020.

7. Pullen E, Oser C. Barriers to substance abuse treatment in rural and urban communities: counselor perspectives. Subst Use Misuse. 2014;49(7):891–901. doi:10.3109/10826084.2014.891615 8. Odgers CL, Caspi A, Nagin DS, et al. Is it important to prevent early exposure to drugs and alcohol among adolescents?. Psychol Sci. 2008;19(10):1037–1044. doi:10.1111/j.1467-9280.2008.02196.x 9. Jordan CJ, Andersen SL. Sensitive periods of substance abuse: Early risk for the transition to dependence. Developmental Cognitive Neuroscience. 2017;25:29-44. doi:10.1016/j.dcn.2016.10.004 10. Misachi J. Drinking Ages Around the World. Drinking Ages Around the World. https://www.worldatlas.com/articles/drinking-ages-around-the-world.html. Published January 7, 2019. Accessed March 31, 2020.

11. NIDA. Common Comorbidities with Substance Use Disorders. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders. February 27, 2018. Accessed March 26, 2020.

12. Chiu ML, Cheng CF, Liang WM, Lin PT, Wu TN, Chen CY. The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study. Psychiatry J. 2018;2018:569 13. Urbanoski KA, Kelly JF. Understanding genetic risk for substance use and addiction: a guide for non-geneticists. Clin Psychol Rev. 2012;32(1):60–70. doi:10.1016/j.cpr.2011.11.002 14. Athamneh LN, Stein JS, Quisenberry AJ, Pope D, Bickel WK. The association between parental history and delay discounting among individuals in recovery from addiction. Drug Alcohol Depend. 2017;179:153–158. doi:10.1016/j.drugalcdep.2017.06.037

Alternative Medicine Krista Mathew, Nikayla Boose, & Skylar Allberry, BSPS Students Spring 2020 Source: https://facultyofhomeopathy.org/the-war-on-naturalmedicine-the-fda-is-threatening-homeopathys-future/

Source: https://www.rockymountainoils.com/organic-lavender.html

Introduction Alternative medicine is defined as any practice for the prevention and treatment of disease that is not usual conventional medicine. A major global health issue concerning alternative medicine is the fact that some of these practices are not regulated and that can cause adverse reactions.

Essential Oils

Acupuncture

Background: Essential oils are concentrated extracts taken from the roots, seeds, leaves, and blossoms of plants. They are used for aromatherapy for various physical and emotional health issues. Essential oils have been used for thousands of years, being traced back to Ancient Greeks and Egyptians. Some examples of the ancient uses include absinthe to repel fleas and treat intestinal worms, and lavender as a sedative and antidepressant.

Issue: Although this practice has been widely used for centuries, the products have yet to be FDA approved.

Therefore, no standard for manufacturing has been established. Another issue is the misuse of the oils.

Without the proper education about essential oils, people are using them in a way that can be harmful.

Essential oils should never be ingested and yet there are users that continue to misuse them in this way. Some oils have caused seizures, nausea, dermatitis, headaches, and it is even possible to overdose. An example of the potential toxicity is a case where a 24- year-old woman developed permanent infraorbital anesthesia and anhidrosis after spilling a small amount of clove oil on her face in an attempt to relieve a toothache. This is just one example of the negative effect oils can have if you are not cautious of the potential risks.

Opinion: Despite the many risks associated with the use of essential oils, I believe they can be used to help people but you should always do your research on the oil and the company you are getting it from. Before you ever try essential oils, you need to be aware of the effects and understand how to avoid them with proper use. ~ N Boose

Background: Acupuncture can be described as a mind and body practice. Small needles are placed in pressure points to simulate internal body responses. Acupuncture originated in China around 2000 years ago.

Issue: Acupuncture comes with risks that are avoidable. The risk is associated with poorly trained practitioners. Serious trauma can occur during acupuncture when needles are inserted in the wrong place or in the skin too deeply. In a review of Chinese literature, adverse side effects were identified and categorized. This review listened that pneumothorax was the most frequently reported adverse event due to acupuncture therapy. They identified that four patients died and others recovered. Along with pneumothorax, they categorize other areas of adverse events such as subarachnoid hemorrhage and bacterial infections.

As already stated, these events can be avoided.

These adverse events usually occur when poorly trained practitioners are performing inappropriate techniques.

Opinion: Acupuncture has been performed for over 2000 years in multiple different cultures. While originating in China it has spread globally across the world and used as alternative medicine. The evolution of this therapy has lead to variation in techniques to best suit the given culture. While acupuncture is associated with risk, if performed by someone well trained these risks go down substantially and better focus on healing the individual. - S. Allberry

Source: https://soflochiro.com/

Homeopathy Background: Created by Samuel Hahnemann, a German physician, in the late 1700s. Most common places homeopathy is practiced is in India, Brazil, Chile, Mexico, Pakistan, and Europe (shown in Figure 1). The three fundamental concepts are: like cures like, law of minimum dose, and single dose remedy.

Issue: Homeopathy is the treatment of a disease using natural substances, such as plants and minerals. Furthermore, homeopathy is not an FDA approved alternative medicine. Moreover, there is not enough research behind this type of therapy to fully understand its effects on the body and how it works. Since it is not FDA approved, sometimes there can be mislabeling of the ingredients, meaning they label some ingredients as natural even though they are active, as 2 stated by the NCCIH. Though not common there is a risk of drug-drug interaction when mixed with other types of medications. According to NCCIH, there have been a few reported cases of drug-drug interactions that were caused from some of the mislabeled active ingredients found in the homeopathic medication.2 As reported by WHO, some of the homeopathic medications are not diluted enough to be considered safe and some of the natural substances being used can be potentially dangerous to consume even 3 if it’s highly diluted.

Opinion: Homeopathy seems like a great method; however, I believe homeopathy should be regulated more due to potential drug-drug interactions and the mislabeling of ingredients. We can solve this issue by researching more about homeopathy, as many healthcare professionals still don't understand the basis of it. ~ K. Mathew

Source:http://h2rc2.com/Homeopathy/Homeopathy/HomeopathyIntro.html

References 1. Kornreich Shawn L. Essential Oils. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. eds. Goldfrank's Toxicologic Emergencies, 11e New York, NY: McGraw-Hill;. https://accesspharmacy.mhmedical.com/content.aspx?bookid=2569&sectionid=210271570 Accessed February 13, 2020.

2. Briggs JP. Complementary, Alternative, and Integrative Health Approaches. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e New York, NY: McGraw-Hill;. http://accesspharmacy.mhmedical.com/content.aspx?bookid=2129&sectionid=192535833. Accessed February 13, 2020.

3. Bellavite P. Homeopathy and integrative medicine: keeping an open mind. J Med Person. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363517/. Published December 14, 2014. Accessed February 13, 2020.

4. Homeopathy. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/homeopathy#hed2. Published July 10, 2019.

5. Safety issues in the preparation of homeopathic mediciatons. https://www.who.int/medicines/areas/traditional/Homeopathy.pdf 6. White A, Cummings TM, Filshie J. An Introduction to Western Medical Acupunture. Edinburgh: Elsevier Saunders; 2018.

7. Acupuncture-related adverse events: a systematic review of the Chinese literature. World Health Organization. https://www.who.int/bulletin/volumes/88/12/10076737/en/. Published March 4, 2011. Accessed March 31, 2020

Chronic Illness Matthew Fernandez (BSPS), Joey Cordill (BSPS) Weize Sun (BSPS) Spring 2020 https://www.purdue.edu/newsroom/purduetoday/ didyouknow/2016/Q1/did-you-know-purdue-seal. html

Introduction The US National Center for Health Statistics defines a chronic illness as a disease or illness that persists for longer than three months. In 2016, the United States spent 1.1 trillion dollars on treatment for chronic health conditions. The Center for Disease Control and Prevention reported that over 1.7 million Americans died from chronic illnesses in 2018. This poster will highlight three chronic illnesses: Alzheimer’s, porphyria, and fatal insomnia syndrome. These three chronic illnesses currently do not have any cures.

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Alzheimer’s Disease that progressively destroys memories and other important mental functions, such as communication, behavior and awareness.

Brought on by the atrophy of cortical and subcortical structures , such as the hippocampus, which is important for memory formation. This destruction is brought on by accumulation of amyloid plaques and inflammation in the brain leading to neuron death. This cell death causes the brain to undergo degradation and shrink, as shown on Figure 1.

There is no cure, but cholinesterase inhibitors aid with keeping memory, while doll therapies, which involve giving dolls to patients, which can aid in dealing with distress by bringing back happy early parenthood memories. Dog therapies also aid in treating agitation and stress associated with Alzheimer’s by allowing the patients to interact with more people Data indicates higher incidence of Alzheimer’s in developing nations, specifically in sub-Saharan Africa and Latin American countries. This is likely due to decreased education, which is a large environmental risk factor for Alzheimer’s and dementia.

In the United States alone, five million people have Alzheimer’s, with 83,000 people dying as a result every year. Alzheimer’s also costs the US $277 billion dollars a year in healthcare costs alone

Opinion: As Americans continue to live longer, Alzheimer’s will continue to become an even larger health crisis. By 2050, the number of cases of Alzheimer’s in the United States will more than quadruple in number. To combat this, there are several actions that must be taken. For one, increased funding in research by the government can aid in providing both a greater understanding in the pathology and epidemiology of Alzheimer's and by providing more financial resources for developing therapeutic interventions. Second, education must be expanded so that everyone can have access to it easily. Research indicates that the more education a person receives, the less likely they are to get Alzheimer’s due to an increase in neuronal density. Making all education, including college, freely available would aid in combating the Alzheimer’s epidemic (M. Fernandez) ● ● ● ● ●

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Different Chronic Ilnesses https://www.lcdhd.org/info-tools/ health-assessments-and-statisti cs/health_report_card/chronic-ill ness/

Porphyria: Disorder that results from a buildup of chemicals that produce porphyrin Porphyria cutanea tarda is the most common type of porphyria and symptoms include red/brown urine (Figure 2), skin rashes, muscle cramps, and severe abdominal pain The acute forms of this disease occur when porphyrins build up in and damage the nervous system Occurs more frequently in northern European countries such as Sweden and the United Kingdom due to autosomal dominant inheritance of gene mutations.

Each form of porphyria results from mutations in either the ALAD, ALAS2, CPOX, or UROD genes. These genes provide instructions for making the enzymes needed to produce heme. Mutations in any of these genes reduce enzyme activity, which limits the amount of heme the body can produce. Porphyrins, which are formed during the process of heme production, can build up abnormally in the liver and other organs Givosiran, a new RNAi therapeutic developed by Alnylam Pharmaceuticals for the treatment of acute hepatic porphyria, was granted priority review by the FDA in August 2019

Opinion: Porphyria is a global issue that isn’t getting enough attention. It is estimated that between 1-5 million people suffer from this chronic illness each year. Although it’s largely inherited genetically, a healthy lifestyle has been shown to help patients living with porphyria. According to the American Porphyria Foundation, factors such as physical/mental stress, alcohol, smoking, and fasting can trigger symptoms of porphyria, which is why it is important to spread awareness to patients and their families (J. Cordill).

Figure 1: Alzheimer’s brain comparison: https://www.nia.nih.gov/health/alzheim ers-disease-fact-sheet

Figure 2: Porphyria Urine https://en.wikipedia.org/wiki/Porphyria #/media/File:Urine_of_patient_with_po rphyria.png

Fatal Insomnia: ● Genetic prion disease that causes neuron loss in the thalamus ● Symptoms include trouble falling and staying asleep (Figure 3), lack of appetite, progressive dementia, loss of coordination and memory, hallucinations, delirium, coma and death within 12-18 months of symptoms ● Inherited genetic mutation of PRNP gene (autosomal dominant),the PRNP gene provides instructions for making a protein called prion protein (PrP), which is active in the brain and several other tissues. ● The PrP has no precise functions known, but it is shown by studies from researchers that this protein can be used for neuroprotection as well as neural cell-cell communications. ● Currently no effective treatment but clinical trials are ongoing. Several forms of immunotherapy have reported success Opinion: I think more testing could be done to find a cure for this disease and more funding for research to find a cure. I think there are ways to alleviate the symptoms such as taking different vitamin B supplements for a few days at a time. Another method to alleviate symptoms is to take melatonin during the mild stages (W.Sun).

References: Fatal familial insomnia. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/6429/fatal-familial-insomnia. Accessed March 26, 2020.

PRNP gene - Genetics Home Reference - NIH. U.S. National Library of Medicine. https://ghr.nlm.nih.gov/gene/PRNP#conditions. Accessed March 26, 2020.

Schenkein J, Montagna P. Self-management of fatal familial insomnia. Part 2: case report. MedGenMed : Medscape general medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781276/.

Published September 14, 2006. Accessed March 26, 2020.

Bernell S, Howard SW. Use Your Words Carefully: What Is a Chronic Disease? Frontiers in Public Health. 2016;4. doi:10.3389/fpubh.2016.00159.

Chronic Diseases in America. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm. Published October 23, 2019. Accessed March 26, 2020.

Facts and Figures. Alzheimer's Disease and Dementia. https://www.alz.org/alzheimers-dementia/facts-figures. Accessed March 26, 2020.

Gorelick PB. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurology. 2004;35(11_suppl_1):2620-2622. doi:10.1161/01.str.0000143318.70292.47.

How Is Alzheimer's Disease Treated? National Institute on Aging. https://www.nia.nih.gov/health/how-alzheimers-disease-treated. Accessed March 26, 2020.

Mortimer JA, Graves AB. Education and other socioeconomic determinants of dementia and Alzheimer's disease . Journal of the American Medical Association. doi:10.36959/734.

Porphyria. U.S. National Library of Medicine. https://ghr.nlm.nih.gov/condition/porphyria#. Published July 2009. Accessed March 2020.

FDA approves first treatment for inherited rare disease . U.S. Food and Drug Administration . https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-inherited-rare-disease. Published November 2019. Accessed March 2020.

Melao A. Certain Dietary, Lifestyle Factors Linked to Lower AIP Disease Activity, Study Suggests. Porphyria News.

Figure 3: http://www.pharmatimes.com/magazi ne/2019/april/patient_files_insomnia

Introduction

Definition According to NASA, climate change is defined as “a long term change in the average weather patterns that have come to define Earth’s local, regional, and global climates”.

These changes have been observed since the beginning of the 20th century and are primarily attributed to human activities, particularly the burning of fossil fuels, which can cause the greenhouse effect. Natural processes can also be a contribution to climate change, such as variations in cyclical ocean patterns, volcanic activity, variations in the Earth’s orbit, and etc.

https://www.businessinsider.com/10-year-challenge-climate-change-photos-2019-1#rivers-and-lakesare-also-shrinking-as-growing-populations-demand-more-water-pesticide-and-fertilizer-runoff-fromfarmland-can-also-pollute-what-little-is-left-7

Changes in Vector Ecology Climate change especially risks the increase of the spread of vector-borne diseases, such as malaria, lyme disease, rift valley fever, and others. Rising global temperatures, increased rainfall or humidity, and human migration can all contribute to the spread of disease-carrying vectors. For example, rising temperatures can promote the migration of mosquitos carrying the zika virus or malaria because of their ability to move away from the equator into more human-inhabited areas. Rising temperatures can also allow vectors to reproduce at a higher rate, as seen with blacklegged ticks, which have a reproductive cycle strongly dependent on higher temperatures. The sheep tick, which is found in Europe, has been found to shift farther north over the past decade due to the north’s milder winters and longer seasons. These vectors are a considerable source of concern all around the world, such as in North America, South America, Africa, and numerous Asian countries.

Increased rainfall or humidity can also pose a risk for vector-borne diseases because it can quicken the process of reproduction for vectors. Flooding can produce many viable locations for mosquitos because of their mode of reproduction of laying eggs in water. In Zambia, an increase of malaria cases was strongly correlated to unusual rainfalls between 2008 and 2010. In Papua New Guinea, malaria trends were associated with climate change in variable locations. Another example is shown in Vietnam, where for every 50 mm of rainfall increase, the amount of dengue cases increase by 1%.

Finally, human migration in response to climate change can pose a risk in catching diseases as their immune systems may not be adapted to their new environment, making them more susceptible to infectious diseases. With this susceptibility, the risk of the spread of infectious diseases is apparent. A major example in 2009-2010 in Greece shows that human migration that occurred due to an economic crisis and a heatwave caused the local transmission of P. vivax to increase.

Opinion:

Understanding that climate change affects the prevalence of vector-borne diseases is important in order to curtail the devastating impacts they can have on present and future populations. It is also important to acutely observe the correlations between weather changes and the subsequent increase of cases so that it can be better proven that climate change is causing effects on diseases. - J Lee

Changes in Food & Nutrition Climate change creates an increase in the overall temperature of the Earth such that crops that are less adapted to extreme temperatures die, resulting in a decrease in food production. With increasing heat due to climate change, livestock will also experience heat stress whereby their body temperature rises, compromising the reproductivity of animals.

Due to a decrease in food production, many people will not be able to receive adequate food intake especially in rural areas or underdeveloped countries. Food security will then be affected. Because there is a decrease in food availability and security, the food economy will also be impacted. That is, there will be an increase in pricings for meals such that people who have lower life chances will be more likely unable to purchase the same amount of food they would normally be able to purchase.This leads to the rise in malnutrition and other diseases such as kwashiorkor, marasmus, etc. Malnutrition can then create other life threatening effects on humans.

This change will cause an impact globally especially in rural areas of the world and developing countries. In Spring 2018, there was a severe flooding incident due to a long and heavy rain and snow storm that was really unusual in the U.S midwest area. This caused farmers to lose $440 million worth of cattle in Nebraska. By losing cattle supply, food production will automatically decrease as well. Due to the flood and heavy rain, farmers were not able to proceed with their annual spring planting as scheduled, causing a delay in food production.

PHRM 485 SPRING 2020

Changes in Sea Level Climate change can have devastating impacts on the weather, which can lead to numerous destructive changes in the environment and its inhabitants. Increasing atmospheric carbon dioxide levels are an immediate concern to be addressed as it can trap greenhouse gases, increasing overall global temperatures and causing ocean acidification. Shrinking ice sheets also present a problem because it can lead to rising sea levels, which can eliminate animal populations dependent on ice sheets for their habit. One extremely prevalent issue is a rise in sea levels due to global warming which puts many things at risk.

Global warming causes sea levels to rise in two ways. First, glaciers and ice sheets worldwide are melting and adding water to the ocean. Secondly, the volume of the ocean is expanding as the water warms. Since at least the start of the 20th century, the average global sea level has been rising and in between 1900 and 2016, the sea level rose by 16-21 cm.

In the US almost 40 percent of the population lives in coastal areas and rising seas may devastate cities located along the coast of the ocean shore threatening infrastructure necessary for local jobs and regional industries. It could also cause the displacement of US citizens and potentially increase the overall poverty level. Also, It could cost the government billions of dollars in money to rebuild city infrastructures.

This issue can directly impact the lives of citizens and lives of future generations so it has to be addressed and discussed.

https://www.climate.gov/news-features/understanding-climate/climatechange-global-sea-level

Opinion:

A rise in sea level is inevitable but we can work to reduce and slow down the process by potentially cutting out fossil fuel use and reducing carbon emissions. Another way is to plant more plants so that it could soak up the rain in the ground and clean the air at the same time.People should try using public transportations often which helps with reducing production of CO2. Also, we could reduce the use of papers that are made out of trees which plays an important consuming CO2 from the environment and soak up water in the ground. - J Han

References:

http://www.climatechange-foodsecurity.org/food_emergency.html

Not only that, delays may cause crops to be unable to withstand the weather change. This is why we believe that climate change will be able to threaten the health and comfort of people over time.

Opinion:

By Caroline Michelle (BSPS) , Jenny Han (BSPS), Jennifer Lee (BSPS)

I think that people should start taking measures to keep our food security and allowing people in rural areas and with lower life chances can still be able to afford food supply as they normally do. With that being said, I think that more education should be provided about this to allow people to know the impact that climate change is going to have towards our lives. More awareness campaign should be made as a way to educate as well. Currently, companies such as Bayer is trying to use technology so that crops will be able to withstand changes due to climate change better and knowing that climate change isn't going to just disappear like that, I think that this is a good way to keep food security. - C Michelle

1. Climate Change and Public Health - Climate Effects on Health. Centers for Disease Control and Prevention. https://www.cdc.gov/climateandhealth/effects/default.htm.

Published September 9, 2019. Accessed February 17, 2020.

2. Fanzo J, Davis C, McLaren R, Choufani J. The effect of climate change across food systems: Implications for nutrition outcomes. Global Food Security. https://www.sciencedirect.com/science/article/pii/S2211912418300063. Published July 3, 2018. Accessed February 17, 2020 3. Cecchi, L., D’Amato, G., & Maesano, I. A. (2013). Climate, Urban Air Pollution, and Respiratory Allergy. Climate Vulnerability, 105–113. doi: 10.1016/b978-0-12-3847034.00116-7 4. Climate Risk and Spread of Vector-Borne Diseases. Climate Nexus. https://climatenexus.org/climate-issues/health/climate-change-and-vector-bornediseases/. Published October 28, 2019. Accessed February 4, 2020.

5. A brief guide to the impacts of climate change on food production " Yale Climate Connections. Yale Climate Connections. https://www.yaleclimateconnections.org/2019/09/a-brief-guide-to-the-impacts-ofclimate-change-on-food-production/. Published October 20, 2019. Accessed March 31, 2020.

6. Lindsey, Rebecca. “5. Climate Change and Sea-Level Rise.” Coasts in Crisis, 2019, pp.

96–118., doi:10.1525/9780520966857-007.

7. Willis, Joshua K., and Ocean Portal Team. “Sea Level Rise.” Smithsonian Ocean, 5 Aug. 2019, ocean.si.edu/through-time/ancient-seas/sea-level-rise.

EPIDEMICS & PANDEMICS

PHRM 485 Spring 2020

COVID-19 (Coronavirus)

Definition

Background: Started with a group of patients with pneumonia that had interaction with seafood and live animal marks in Wuhan, China (suggests animal-to-person spread). A positive ressult of the virus was first reported on Dec. 31, 2019, after Li Wenliang, a Chinese ophthalmologist, warned fellow colleagues about a possible outbreak.It spreads like influenza, which is highly transmissible through person-to-person spread via respiratory droplets. Symptoms vary from mild to severe, such as shortness of breath, fever, coughs, pneumonia, and even death.

Testing for COVID-19 involves a nasopharyngeal swab. Thus far the only form of treatmeant is supportive care, however tx and vaccines are currently in development. There is some suspicion that Hydroxychloroquine and Azithromycin can cure the virus.

Origins and evolution: Opioid addiction can be traced back to 1980 when a letter published by the New England Journal of Medicine glossed over a study conducted by a Boston University professor that tested over 11,000 patients for if they developed an addiction to prescribed opioids in an inpatient setting. The study concluded that an overwhelming majority of those patients did not gain an addiction to the prescribed opioids. This finding is what major pharmaceutical companies like Purdue Pharma used as a catalyst for their aggressive marketing campaigns for opioids such as oxycontin to be pushed out into the market for public consumption.

Intercultural Impact: As we know now, opioids ARE addictive substances have played a large role in increasing mortality rates due to overdose of opiates. The CDC has outlined that more than 230,000 Americans have lost their lives to overdoses involving prescription opioids since 1999.

https://www.cdc.gov/vitalsigns/opioid-overdoses/infographic.html

Solutions:

Opinion: The opioid epidemic is a problem that is currently being treated with a bandaid. It is our responsibility to better regulate the use of illicit and synthetic opioids to lower the overall death-toll the US is experiencing right now -R. Lazareto

Global impact: Global deaths have passed 40,000 and is affecting 201 countires. Many counties have ordered for lockdowns, shelter-in-Place actions with people adapting remotely. Hospitals are at capacity with limited ICU beds and supplies, such as ventilators and masks. Small business are hitting a financial crisis, which will put countries in a recession in the near future.

Opinion: Some people in the US still do not realize how serious COVID-19 is, and it puts a huge risk on otthers. By practicing social-distancing and taking extra-precautions, will “flatten the curve” of the virus. We do not want to get to a point where physicians will have to choose which patients to save, as resources will become limited. -A. Lam

Malaria

https://www.livescience.com/coronavirus-flatten-the-curve.html

Background: Malaria is a parasite that is transmitted from person to person due to infected mosquitoes. The parasite reproduces in a host’s blood causing fever, chilling and pain amongst other symptoms. In the worse cases the disease leads to coma and death. In 2017 it was estimates by the World Health Organization (WHO) that over half a million children passed away from the disease.

Global impact: Over the last century affected regions has decreased and the primarily affected regions sub-Saharan Africa, central/southern America and southeast Asia. To decrease areas affected by malaria, widespread use of insecticides decrease mosquitoes populations and swamp land has been drained to restrict breeding grounds of the disease carrier. Additionally, economic development has allowed for improvements in housing conditions in rural Africa, lowering the diseases ability to spread to new hosts, and more importantly protecting children under the age of 5 from being exposed. https://ourworldindata.org/malaria

Opioid Crisis

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/

Amy Lam BSPS, Aaron Hjermstad BSPS, Rico Lazareto BSPS

Treatment: Antimalarial drugs, such as artemisinin-based combination therapies (ACTs) and chloroquine phosphate Opinion: In my opinion malaria is a largely overlooked disease in Western society. With the ever present threat of climate change and global warming, it is likely that we will see malaria get reintroduced into western societies, that are unequipped to handle the disease. -A. Hjermstad

This curve refers to the projected number of people who will contract COVID-19 over a period of time.

The faster the infection curve rises, the quicker the local health care system gets overloaded beyond its capacity to treat patients.

In contrast, a flatter curve, assumes the same number of people who ultimately get infected, but over a longer period of time. A slower infection rate will allow less stress on the health care system and fewer ill patients being turned away.

References: 2019 Novel Coronavirus (2019-nCoV) Situation Summary.

(2020, February 13). Retrieved from https://www.cdc.gov/coronavirus/2019-nCoV/summary.html Murthy, V. H. (2020, February 12). Ending the Opioid Epidemic - A Call to Action: NEJM. Retrieved February 17, 2020, from https://www.nejm.org/doi/full/10.1056NEJMp1612578 Novel coronavirus (2019-nCoV). (2020, January 31). Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Opioid Overdoses Treated in Emergency Departments. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html. Published March 16, 2018.

Accessed March 28, 2020.

Phillips MA, Burrows JN, Manyando C, Huijsduijnen RHV, Voorhis WCV, WellsTNC. Malaria. Nature Reviews Disease Primers. 2017;3(1). doi:10.1038/nrdp.2017.50

Housing and Health Sophia Meyer, Trev Parker, Devin Bingham, and Ariana Thompson: BSPS Spring 2020

Introduction At the very facet of a person is their home or living condition. Poor housing conditions can be associated with a wide range of health conditions including injuries, mental health issues, hunger, and infectious disease. Public health is deeply tied to human health, and therefore becomes a major area of investigation for solutions to some of the prominent housing issues.

Tent City

Food Deserts

Tent City: Encampment of people experiencing homelessness in a living situation of self-sheltering.1 A Primarily Domestic Health Issue ● On a given night in 2017, an estimated 553,742 people in the U.S. were homeless, about one-quarter to one-third of them unsheltered.2 ● Minimal Access to Resources ○ Hygiene facilities, food storage, healthcare, and rehabilitation ○ Inability to locate families ○ Increased risk of communicable diseases ○ Increased vulnerability for arrest ● People in tent cities are often forced to relocate by non-loitering legislation, a synergistic factor in the lack of available resources Factors Contributing to Homelessness14 ● General lack of shelter space ● Inadequacies with shelter system in certain locations ● Lack of attentiveness by service providers and state and local governments ● Lack of political will to devote sufficient resources to addressing the problem in long-term Professional Opinion: I am saddened to know that tent cities are an unsafe community, largely because of the unwelcoming politics that consistently push the inhabitants of tent city into nomadism, looking for whatever spot they can temporarily stay until their next brutal and forced relocation. I feel that with proper aid and intervention, these communities could support rehabilitation, basic healthcare, medication, food supply, and sanitary infrastructure for those living in tent city without basic human needs. While the issue at hand for finding a permanent solution for the health problem that is tent city is much larger than the small remediations that I propose, I feel that these minute efforts of financially stable communities can significantly improve the health quality of those struggling for their lives in tent city. -S. Meyer

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.kazu.org%2Fpost%2Fclosure-date-looms-tent-city-santa-cruz&psig=AOvVaw2UnqriFd4TBYBpHWJaa JHY&ust=1582145841828000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCKCfs93-2-cCFQAAAAAdAAAAABAD

Food desert: Geographic area in which access to affordable, fresh, and healthy food options is either limited or nonexistent for residents due to the absence of grocery stores within convenient traveling distance.

Housing Impacting Health ● Public transportation allows some urban residents to overcome the difficulties posed by distance; however in suburban and rural areas, public transportation may be restricted or unavailable. ○ Supermarkets may often be located many miles away from resident homes. ● Substantial research indicating that diet plays a key role in the prevention of chronic diseases and obesity, which highlights the role of nutrition as one of the modifiable determinants of chronic diseases. 3 Socio-economic Considerations ● Most commonly found in black and brown communities and low income areas, where many people do not own cars3. ● Corner delis and convenience stores offering cheap, processed foods are generally found in high concentrations in lower socio-economic areas.3 ● The USDA estimates that approximately 23.5 million people, or 8.4% of the US population, live in 2015 Low Income and Low Access Areas (> 1 mile urban, > 10 miles rural)15 4 low-icome neighborhoods that are more than a mile away from a supermarket.

Potential Solutions ● Increasing the concentrations of grocery stores offering fresh food options ● Increasing the consumption of fruits and vegetables, whole grains, and calcium-rich foods, while reducing saturated fats, trans fats, sodium, added sugars, and excess calories Professional Opinion: The issue of food deserts is complex. Increasing the number of grocery stores that offer affordable and fresh food options in both rural and urban areas should be the first step in alleviating income and racial/ethnic disparities in access to healthy foods. I’d imagine that this process could be encouraged and accelerated through subsidies, tax breaks, and other incentives for large chain, and even smaller family-owned, grocery stores. If possible, limits should be placed on the concentration of fast food establishments allowed in a given area. It is no secret that fresh food options tend to be more expensive than processed foods so while access to fresh foods is an issue, price remains equally important, especially for low income families. Further, while increased numbers of grocery stores can yield greater access to fresh foods, the onus of leading healthier lives ultimately falls on the individuals who need to make healthy choices with regards to diet. However, individual behavior to make healthy dietary choices can only occur in a supportive environment with accessible and affordable healthy food options, which accentuates the complex relationship between food deserts and health. -D. Bingham

Government Housing

Gentrification Gentrification: the process of making something more respectable. In terms of housing, it's associated with renovating and improving neighborhoods so that they have a more affluent character. While attracting more upper class residents to new and improved neighborhoods, this process of gentrification pushes out the lower 8 income residents who lived there first .

Gentrification Pros ● Gentrification often improves the economic value of houses and neighborhoods ● Lower income communities become more appealing ● Attracts more middle to upper class resident Gentrification Cons ● Displaces lower income families to other areas of worse crime and poverty ● Cities become even more gerry-mandered as low income families are excluded to certain parts of the city The process of gentrifying communities is happening all across the country (and world), mainly in well populated cities. According to CBS News “the rich are definitely pouring into another Los Angeles zip code: 90014. That neighborhood is now America's "most gentrified" zip code in the country, even though it's next to the city's Skid Row.7 Besides Los Angeles, other places where gentrification is occurring is in Seattle, Portland, DC, and even can be seen throughout Lafayette, Indiana.

Professional Opinion:My opinion on gentrification is that it is unavoidable. Naturally, urban areas are going to be redeveloped into something more modern to fit the times we are living in. I also think gentrification can be a good thing. The modernization of neighborhoods brings more money into the area, while also reducing crime. However, this can also push people of lower incomes into areas of crime or neglect.The only way to really fight gentrification is to become an activist in your community, or to become active in politics where you may have a say on affordable housing and zoning permits -T. Parker

Source: USDA Economic Research Service, ESRI. https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation

https://res.cloudinary.com/blavity/image/upload/c_fit,g_center,h_250,q_auto:best,g_south_east,x_0/v1543978098/ur6liphli3bkr4kl8sn4

Government Housing: established housing available for elderly, disabled, and low-income families12 ● available all across the U.S ● available only to low-income families who make less than 50% of the average income of the country they reside-- 2.3 million Americans are currently benefiting 13,15 Issues13-15 ● There are far more families that qualify for government housing, than available spaces in the public housing communities ● Many individuals and families are placed on a waiting list, where they sometimes wait months and often years before they are placed in a unit, facing the cycle of poverty and homelessness ● Many government housing options are of poor quality with unusable appliances ● Housing funds improperly allocated or managed Professional Opinion: I personally feel that the issue of government housing is growing, as the rich get richer and the poor get poorer. The fact that some families wait years before being placed in a home is problematic. If the government were to increase the amount of federal aid designated to government housing, this would provide a solution for the many issues associated with public housing, improving the living situation of thousands of families, and decreasing the number of individuals who are homeless. -A. Thompson

https://www.rentprep.com/landlord-tips/section-8-inspection-guide-for-landlords/

References: 1.

2.

3.

4.

5.

6.

McNicholas, Rosenblum, Ryan, et al. TENT CITY, USA: The Growth of America’s Homeless Encampments and How Communities are Responding. Washington DC: NLCHP; 2018: 7. Accessed February 4, 2020. Available at https://nlchp.org/wp-content/uploads/2018/10/Tent_City_USA_2017.pdf.

Kushel M, Ucsf. The rise of California's tent cities. University of California. https://www.universityofcalifornia.edu/news/rise-californias-tent-cities. Published June 15, 2018. Accessed February 4, 2020.

Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences. US Department of Agriculture. Published June 2009. Accessed February 4, 2020. https://www.ers.usda.gov/webdocs/publications/42711/12716_ap036_1_.pdf?v=41055 Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. American journal of preventive medicine. 2002 Jan 1;22(1):23-9. Accessed February 4, 2020. https://www.ncbi.nlm.nih.gov/pubmed/11777675 Examining the Impact of Food Deserts on Public Health in Chicago. Mari Galleghar Research & Consulting Group. Accessed February 4, 2020. http://www.marigallagher.com/2006/07/18/examining-the-impact-of-food-deserts-on-public-health-in-chicago-july-18-2006/ Food Deserts in America. University of Tulane. Published May 2018. Accessed February 4, 2020. https://socialwork.tulane.edu/blog/food-deserts-in-america

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Leefeldt E. Where gentrification is having the biggest impact on cities. CBS News. Published March 5, 2018. Accessed February 5, 2020. https://www.cbsnews.com/news/does-gentrification-help-or-hurt-our-major-cities/.

Gentrification And The Effects On Urban Development Sociology Essay. UKEssays.com. Accessed February 5, 2020. https://www.ukessays.com/essays/sociology/gentrification-and-the-effects-on-urban-development-sociology-essay.php Blake, kellerson, Simic, et al. Measuring Overcrowding in Housing. Bethesda, Maryland: IFC International; 2007: 6-9. Available at https://www.huduser.gov/publications/pdf/measuring_overcrowding_in_hsg.pdf Urbanization Effects. Urbanization Causes and Impacts | National Geographic. https://www.nationalgeographic.com/environment/habitats/urban-threats/. Published June 18, 2019. Accessed February 5, 2020.

ACLU. Overcrowding and Overuse of Imprisonment in the United States. New York, New York: Office of the High Commissioner for Human Rights; 2015: 1-3. Available at https://www.ohchr.org/Documents/Issues/RuleOfLaw/OverIncarceration/ACLU.pdf Hud’s Public Housing Program. Washington D.C. U.S Department of Housing and Urban Development. https://www.hud.gov/topics/rental_assistance/phprog Problems with Public Housing. https://homeguides.sfgate.com/problems-public-housing-1907.html. Accessed 2018 Hunter, Linden-Retek, Shebaya, et al. Welcome Home The Rise of Tent Cities in the United States. Allard K. Lowenstein International Human Rights Clinic Yale Law School. 2014. Accessed March 22, 2020. Available athttps://law.yale.edu/sites/default/files/documents/pdf/WelcomeHome_TentCities_final_report.pdf 2015 Low Income and Low Access Areas Data Atlas. United States Department of Agriculture. Accessed April 5, 2020. https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation

Human Trafficking: A Modern Intercultural Health Issue

Addiction

Introduction Human trafficking (HT) is defined as the action or practice of illegally transporting people from one area to another. However, human trafficking is not always the transportation of people and does not always mean people are confined. Two types of human trafficking are labor and sex trafficking. The subtopics that will be described in this presentation are: mental health, preventative health care, addiction, and chronic illness.

This is a growing problem around the world that is leading to increased adverse health effects.

https://ceufast.com/course/human-trafficking

Effects on Mental Health • Higher likelihood of developing mental disorders like schizophrenia [1] • “15 percent of trafficked persons in contact with mental health services in South London between 2006 and 2012 met criteria for schizophrenia and related disorders in the International Statistical Classification of Diseases and Related Health Problems” [1] • People that are trafficked with pre-existing psychological disorders will require more support than those suffering from the same mental illness • Survivors tend to have higher instances of PTSD, anxiety, depression, self-harm, and attempted suicide [1] • Stockholm syndrome (i.e., traumatic bonding with perpetrator) is commonly seen [2] • Dissociative disorders involving varying degrees of detachment from self/reality • Sleep disorders (e.g., sleep disturbances, nightmares, and insomnia)[1] • Trafficker will claim that they have a mental disorder- may be an indicator to a physician that this might be a trafficking scenario. [1] I believe this is of greatest importance. This effects most everyone that goes through HT. It seems to be both what is targeted by HT leaders, but it can also be an important indicator for health professionals to recognize HT is going on. Since this effects so many HT patients in a traumatic and life altering way, I think that this is the greatest health concern with HT patients and the most emphasis on getting treatment for HT patients should be put on mental health. ~ A Reidel

https://news.un.org/en/story/2019/01/1031552

Access to Preventive Healthcare • Difficult for health care professionals to do proper assessments of HT victims due to their increased sensitivity and possible recent abuse • HT victims are at an increased risk of contracting sexually transmitted infections and reproductive issues such as unplanned pregnancy, abortions, and dyspareunia [3] • It is common for abortions to be preformed by persons that are not qualified and lead to later pregnancy complications and infection • It is common that HT victims have never had any sort of medical care, specifically preventative • Poor access to barrier protection or other contraceptive • HT victims have been forced to be sterilized • HT victims can be forced to give birth childbirth or be forced to terminate a pregnancy[4]

• Survivors who are vulnerable are made even more vulnerable when addicted to substances • Traffickers administer drugs to force someone to cooperate which may lead to addiction [5] • Mental and physical traumas associated with trafficking are dealt with by drug addiction • “...an anti-trafficking service provider in Maine found that 66 percent of its clients reported that substance use led to their being trafficked while only 4.5 percent reported that it arose after their being trafficked.” [1] • US sex trafficking survivors survey found that substances were used by 84.3% of survivors during their trafficking [1] • Same survey found that greater than 50% of survey participants used cocaine, alcohol, and marijuana, and heroin was used by close to 25% of the participants [1] • There is a link between US human trafficking and the opioid epidemic • Opioids are beneficial for traffickers to give to survivors, because they relieve their physical and emotional pain • Treatment centers for substance abuse have been areas where survivors have been taken for trafficking [1] • Survivor: “He made me believe that he cared and that he loved me, and he was going help get me off the streets.... Instead he got me addicted.... [The drugs] were all bought illegally for the purpose of addicting me and controlling me” [1] I think survivors with addiction problems need special treatment facilities where they can get help from professionals that communicate with other human trafficking survivors. Also, I think there should be more awareness brought to treatment centers for substance abuse about trafficking that may occur there. ~A Borici

Conclusion The trauma experienced has a significant impact on mental well-being. Many times this can cause disorders such as PTSD or generalized anxiety. However, there is a flip side to the mental health aspect in that if someone seeks treatment from a physician and the person that brought them in claims they have a mental disorder and won't let the patient talk this can be a sign that there is HT going on.

The lack of access to preventative healthcare for HT victims is cause for breeding grounds of STI and STDs. The outcome of this for a woman specifically could take away her ability to bare children and start a family.

Addiction is a method that is used by the traffickers to make sure that the survivor will cooperate with them. In some cases, the survivors were substance abusers before being trafficked. The addiction problems of survivors of human trafficking is important to treat, in order to have productive citizens.

References 1.Stoklosa, Hanni, Marti MacGibbon, and Joseph Stoklosa. 2017. Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing. AMA Journal of Ethics 19 (1): 23-34.

2. Ottisova L, Hemmings S, Howard L, Zimmerman C, Oram S. Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review.

Epidemiology and Psychiatric Sciences. 2016;25(4):317341. doi:10.1017/s2045796016000135 3.Greenbaum J, Crawford-Jakubiak JE. Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims. Pediatrics. 2015;135(3):566-574. doi:10.1542/peds.2014-4138 4. Bick, Debra, et al. “Maternity Care for Trafficked Women: Survivor Experiences and Clinicians’ Perspectives in the United Kingdom’s National Health Service.” Plos One, vol. 12, no. 11, 2017, doi:10.1371/journal.pone.0187856.

I think that reproductive health in HT is important because it not only affects the person that was trafficked but also the child, if that is the outcome of a lack of preventative healthcare. Not to mention the effects of the illness that can come along with a lack of preventative health care, including abortion that could cause infection and take away a woman's ability to have another child. ~ T Stilwell

5. Deshpande NA, Nour NM. Sex trafficking of women and girls. Rev Obstet Gynecol. 2013;6(1):e22–e27.

http://www.supremecourt.ohio.gov/JCS/specDockets/conference/2018/materials/G9/G9.pdf

IMMUNIZATIONS Authors: Kayleigh Yaeger(PharmD Student), Brenden Yoon (PharmD Student), Alex Plumer (PharmD Student)

I n t r o d u c t i o n

Spring 2020

Immunizations are an amazing advancement in healthcare that greatly decreases the chance of getting a disease. There are many issues with the concept of immunizations that hinder the potential of this aspect in modern healthcare. Here, we have touched on just the surface of the problems that are reducing the benefit to an advancement in healthcare that has so much potential and could help the world to become overall healthier.

Education of Vaccinations

Vaccines have been a topic of conversation that is increasing in popularity of the last decade. It has been said that vaccines can cause health conditions to anyone who gets them with little to no evidence. This claim has caused a decrease in the amount of people receiving vaccines and has weakened the herd immunity that has been built up over decades. According to Renee Slade from Rush University Medical Center, “there’s no relationship between any vaccine and autism.” The article continues to state that “autism is determined before birth” which means that vaccines have no part in this determination.

Another concern many consumers have when it comes to vaccinations is that the disease they are trying to protect the consumer against can actually cause the disease.

According to Rush University, “vaccines do not contain active virus,” therefore the vaccine cannot cause the disease. This is slightly correct because some viruses do contain active virus, but it is not a large enough amount to potentially cause the disease the vaccine is treating against. When it comes to global vaccine practices, some countries have stricter reigns on their population. According to an article by Charlotte Moser from the Children’s Hospital of Philadelphia, “Latvia and Slovenia have mandatory vaccine programs which yield vaccination rates of over ninety-five percent.” This is something that has kept the countries’ herd immunity strong for mandatory vaccines and incidence rates low.

According to the article, the Latvian government pays for the required vaccines and is a big factor in why vaccine rates are so high. This is important because it can be inferred that the government has educated the population on why these vaccines are important.

When it comes to some underdeveloped countries throughout the world, patient education is very poor in regard to vaccines. According to an article written by Mandip Jheeta and James Newell for the World Health Organization, “parents’ knowledge about vaccination is poor, and the knowledge they do have is often wrong.” This is important to address because the quality of life of these people and their children is something that is much lower than it can be. One issue that comes with this though, countries like India, Ethiopia, and the Philippines lack the resources that are necessary for proper vaccine practices. With the lack of resources, patient education cannot be conducted the way that it should be and each country has suffered because of it.

Opinion: Vaccines are a crucial part of maintaining a country’s immune system. Without large numbers of citizens participating in immunization practices, the country’s herd immunity begins to weaken. A reason for this weakening is a lack of education on why vaccines are important and the role that they play in a country’s health. It is not only a lack of education that causes this weakening, it is also being able to decipher between fact and fiction when it comes to the information presented. By making consumers more aware of how vaccines work and how they help, this can in turn increase a country’s health. ~KYaeger

Legislation

People’s motivation shows the same patterns all around the globe. They do not want to be threatened, but also they do not like to be forced to do something even if that something is the right thing to do until they pay for the consequences. This same concept applies to immunization. The main reason vaccine preventable diseases always come back and make a spread is due to the unvaccinated population. To alter this tricky business and ultimately improve the health and decrease mortality of our humanity, governments all around the world implemented policies regarding immunization. The answers to increasing the rate of immunization may vary around the globe. Currently in the United States, all states require vaccinations to attend schools, including preschool programs, but there’s always a minority group that may not be vaccinated for one reason or another.

The U.S. is currently adequately established in immunization policy and has relatively high vaccination rates compared to other countries. Dr. Tim Lahey, a professor at Dartmouth Institute for Health Policy and Clinical Practice, stated ”this policy has been effective and increased the likelihood that children get immunized.” People generally do not see the requirement as a punishment but positive reinforcement since vaccination and school are positives that people want for their children.In comparison, European immunization rates are high overall. However, it has constantly shown that vaccine preventable diseases such as measles, continue to spread where vaccination rates have declined, said WHO in 2016. France contributed 3% of these cases, but the majority of cases occurred in Italy (37%), Romania (35%), Germany (9%), and United Kingdom (5%), according to the same report. To address issues, Italy essentially followed the lead of the United States, which requires vaccination for school attendance, with a few twists.

Parents have to provide proof of vaccination when enrolling their children in government-run nurseries or preschools, just as is done in the United States. But the parents of children who have not been vaccinated will be fined. Similarly, Germany introduced legislation recently that made immunization mandatory for all kindergartens to report to the health authority if parents have not submitted proof of vaccination counseling for their children. This policy marked a vest change in German law, which had required parents to submit proof that they have attended vaccination counseling before enrolling their children in kindergarten.

In addition, in Asia, as many as one in four children remain under-immunized. We can see that South Asia and West and Central Africa are the lowest in vaccinations. In 2012, 8 million of the world’s 23 million under-immunized children lived in South Asia, most of them in India, Pakistan, and Afghanistan. The main problem with these countries is being unable to supply because they do not have the resources to endorse healthcare. The temporary solution is to get support from UNICEF and other agencies. This has shown some improvements on vaccination rates, however, their numbers are still extremely low.Unless people are part of third world countries, the challenge the U.S. and most European countries face is the small minority groups that react against the incentive and refuse to get immunizations for their children. Dr. Lahey claimed that if government authority cannot change these groups, perhaps it is best to encourage people in their social circle to put vaccination forward as “a social norm, that, does seem to encourage people to be more likely to get vaccination.”

Sherry Young/stock.adobe.com

Discovery & Research

The first major step in vaccine development is called the exploratory stage, which is governmental or academic research trying to identify the antigens on the microbe that is the target for the vaccination. This could consist of toxins, weakened microbes, weakened viruses, or just certain parts of the microbe that would still stimulate an immune response. This takes about 2-4 years normally. Then, the second step of the process is called the “pre-clinical stage.” This is where the cell culture studies and animal studies take place. This is where the vaccine is assessed for its ability to stimulate an immune response, as well as the safety of the formulation.

This part of the process takes roughly 1-2 more years on average.

After the formulation has been tested a substantial amount of times in the animal studies, the company that has produced the vaccine must submit an IND application. This stands for an investigational new drug application, which will allow the formulation to enter Phase I trials.The phase 1 vaccine trials are tested in about 20-80 patients, which is testing the safety and efficacy in humans. If the vaccine is made for children, it will be given to adults first and then worked down into children.

The study assesses what kind of immune response the vaccine stimulates in the body, if any.

If the vaccine has a promising turnout in phase I, it will advance to Phase II trials.

Phase II trials will consist of hundreds, and maybe even thousands, of patients. This part of the process is here to assess the vaccine’s safety, immunogenicity, proposed doses, schedule of immunizations, and method of delivery. Phase III trials are just a more intense version of Phase II. This step consists of tens of thousands of people, but the outcome is trying to figure out the rare side effects that may not be observed in a smaller population. The efficacy is also assessed again in this step.After all this testing, the vaccine developer will submit a Biologics License Application to the FDA. Then the Federal Drug Administration will inspect the factory where the vaccine will be made and approve the labeling of the vaccine. After the drug has been approved for distribution, the FDA will continue to monitor the facility. The vaccines must continue to stay effective, safe, and pure.

Opinion: I believe that we have a huge potential to benefit from developing vaccines for the diseases that affect a large number of the population. Preventative care for individuals will help to reduce the amount of money spent on healthcare in the nation, as well as improve the quality of life for those who may have been affected if they had not received the vaccine. People who live in developing countries may not have close access to the site that gives vaccinations, which may lead to a decreased herd immunity, leading to a larger prevalence in the preventable disease. Something that causes the vaccination development process to be so difficult is the amount of cost and the time commitment, which is also hard to weigh the benefit because the diseases may decline or mutate while the development of the vaccine occurs. ~APlumer

THE ENTIRE PROCESS TAKES ABOUT 10-15 YEARS.

https://www.gsk.com/en-gb/research-anddevelopment/development/how-we-develop-new-vaccines/

Opinion: Not everyone prefers to get vaccinated due to various reasons including false facts about vaccinations and lack of trust with pharmaceutical companies or personal preferences that lead to refusal of immunization. However, this becomes a problem when it affects others in the population, herd immunity. There are so many factors to consider to account for every individual’s preferences when we try to increase the rate of vaccinations. There are multiple ways to implement vaccinations, however the most effective and efficient way to encourage people to get immunized is to make vaccination as a requirement. By enforcing this new policy, people who want to attend or work in public with others, they are obligated to get immunized. Ergo, this will result in an increase in the rate of vaccinations and improves global health issues overall. ~BYoon

R e f e r e n c e s

Slade R. 7 Myths About Vaccines. Rush. https://www.rush.edu/health-wellness/discover-health/7-myths-about-vaccines. Accessed February 18, 2020.

Dadonaite B, Roser M, Vanderslott S. Vaccination. Our World in Data. https://ourworldindata.org/vaccination. Published July 2015.

Updated December 2019. Accessed February 18, 2020.

Moser C. Children's Hospital. Around the World: Vaccine Requirements Vary From Country to Country. Children's Hospital of Philadelphia. https://www.chop.edu/news/vaccine-requirements-vary-country-country. Published March 17, 2015. Accessed February 24, 2020.

Gracia JN. Vanderslott S, Dadonaite B, Roser M. Vaccination. Our World in Data. https://ourworldindata.org/vaccination. Published May 10, 2013. Accessed February 24, 2020.

Jheeta M, Newell J. Childhood vaccination in Africa and Asia: the effects of parents’ knowledge and attitudes. World Health Organization. https://www.who.int/bulletin/volumes/86/6/07-047159/en/. Published June 2008. Accessed February 18, 2020.

Scutti S. Encouraging vaccination around the world. CNN. Pushed January 2, 2018. Accessed March 19, 2020.

Benzie A. How we discover new vaccines. GSK India. https://india-pharma.gsk.com/en-in/research/our-approach/how-we-discover-newvaccines/. Accessed February 24, 2020.

Offit, P. Vaccine Development, Testing, and Regulation. History of Vaccines. https://www.historyofvaccines.org/index.php/content/articles/vaccine-development-testing-and-regulation. Accessed February 24, 2020.

Hasman A, Noble DJ. Childhood immunization in South Asia – overcoming the hurdles to progress. Perspectives in Public Health.

2016;136(5):273-277.

Moser CA. Around the World: Vaccine Requirements Vary From Country to Country. Children’s Hospital of Philadelphia. https://www.chop.edu/news/vaccine-requirements-vary-country-country. Published March 17, 2015. Accessed February 18, 2020.

Infectious Disease

Matt Masters (BSPS), Nate Loh (BSPS), Ken Amagai (BSPS)

Introduction

Infectious diseases are caused by the invasion of the body by disease causing microorganisms such as bacteria, viruses, and parasites. It is a

global health issue and can a ect anybody, of any age, from any country. However, its prevalence and mortality rates are significantly higher in areas with lower-income and less access to medical care. The introduction of antibiotics in the early 20th century revolutionized medicine and brought us some of the same life-saving medicines we use today. For example, penicillin, which was a natural product discovered in a species of mold was found to have strong antibiotic properties. This discovery not only led to a better understanding of antibiotics, but has estimated to have saved up to 200 million lives and continues to save millions today. 1 However, even with these advances in treatments and technology, infectious disease still represents a lasting global health issue with major e ects on society.

Antibiotic Resistance

Hospital-acquired Infections

Source: http://modmedmicro.nsms.ox.ac.uk/learn-more-about-antibiotic-resistance/

Bacteria can develop drug-resistance through exposure to antibiotics, causing them to be more di cult to treat.

Bacteria can then pass on these genetic mutations to other bacteria, causing widespread resistance to commonly used antibiotic medications. It is a natural phenomenon but has been made worse through over prescription of antibiotics as well as improper disposal by manufacturing facilities.

According to the World Health Organization, antibiotic resistance is “one of the biggest threats to global health, food security, and development today”.2 Resistant infections often require alternative treatments which are usually more toxic, more expensive, and require longer hospitalization.3 The mortality rate of drug-resistant infections is also often higher than a typical infection. For example, a drug resistant bacteria called CRE is associated with a two to five fold increase in the risk of death compared to the non-drug resistant strains. This bacteria is now an emerging threat to the healthcare system as it presents significant risk to those infected.

Source: https://www.slideshare.net/DrArunKumarPandey2/2-hospital-acquired-infections https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1733452

Hospital-acquired infection (HAI), also known as nosocomical infection, is an infection caused by viral, bacterial, and fungal pathogens. It can occur in all settings of care including hospitals, surgical centers, ambulatory clinics, and long-term care facilities such as nursing homes and rehabilitation facilities.8 Some common HAIs are Clostridioides di cile, urinary tract infection (UTI), and methicillin-resistant Staphylococcus aureus (MRSA). All hospitalized patients are susceptible to contracting HAIs however, young children, the elderly, and patients with compromised immune systems are more likely to contract with an infection. Risk factors include long hospital stays, the use of indwelling catheters, failure of healthcare workers to wash their hands, and overuse of antibiotics.9 The World Health Organization estimates HAI accounted for about 1.7 million infections and 99,000

What can be done?

associated deaths each year, yet its global statistics and burdens remain unknown; this is because most counties

● Reduce unnecessary antibiotic usage including misdiagnoses ● Proper disposal of antibiotic drugs (by patients and manufacturers) ● Discovery of new antibiotic mechanisms that are more di cult to develop resistance against

lack surveillance systems for HAI.10

Professional Opinion

Professional Opinion

HAIs lead to increased patient morbidity and mortality risks, longer hospital stay, reduced quality of life as well as

It is incredibly important that resources are dedicated towards the research and development of antibiotics that act additional costs for the treatment, which put health and economic burden to a significant level. Therefore, by a novel mechanism of action. In particular, molecular targets should be selected that are di cult to develop e cient and e ective hygiene practices must be done in order to prevent or reduce any possible risk of mutations against, and also don’t exist in human patients. With the advantage of state-of-the-art sequencing co-infection because invasive devices and procedures (UTI and surgery) bypass the body’s normal defense systems technology and increased computational power, researchers now have the ability to search for new molecular and they contribute to more than half of HAIs. A great precaution is needed particularly when handling targets by using genetic information. This represents a powerful tool that will guide the future of antibiotic drug patient-care equipment, making contact with others, protecting from droplet and airborne transmission. (K.

development. (M. Masters)

Amagai)

Tuberculosis

Tuberculosis (TB) is a chronic disease that generally a ects the lower respiratory system (incubating in the lungs), though the bacteria that cause the disease, Mycobacterium tuberculosis, can spread to many areas throughout the body, namely the intestines, kidney, spine, and brain.4 The symptoms of TB are severe, and include a rapid decrease in weight, coughing up blood, and extreme fatigue.5 As mentioned before, TB infections normally begin in the lungs, where immune cells work to engulf and kill them. In many cases, the bacteria survive, sometimes multiplying and manifesting itself into a noticeable disease, and other times remaining dormant within the lungs, allowing for unknowing spread of the disease through air transmission (termed Latent TB infection). Because of the evasiveness of the bacteria, treatment normally lasts up to six months of antibiotics.6 In many developing countries, where most of the 1.5 million deaths a year from TBI come from, it may be di cult to keep up with this treatment routine, or impossible to even obtain the medication they need. Left untreated, TB results in the death of half of all patients, and other related morbidities in the rest of the population. Incomplete antibiotic treatment has led to the development of multi-drug-resistant TB (MDR-TB) and extreme-drug-resistant TB (XDR-TB) that can take up to 24 months of combination therapy to cure, if it can be cured at all.7 Moving forward, e ective control of TB at this point requires more e ective communication of the dangers of stopping antibiotic use early, better diagnostic techniques/tools to catch TB early or in the latent phase, general improvements to the health infrastructure and health education in at-risk countries/populations, and looking in to novel drugs and vaccines to reduce treatment length and fight against drug resistant strains.7

Professional Opinion Tuberculosis is a particularly nasty bacterial disease that has been around since ancient times. This is a disease whose prevalence and mortality over the course of history is comparable to influenza, but has remained a major health crisis into the modern day, while the flu has been somewhat successfully mitigated. TB was actually the first infectious disease that the World Health Organization classified as a global health emergency, and I cannot find any reason to disagree with this title. Mycobacterium tuberculosis is present in nearly every part of the world, and provides a significant threat to one’s life in most developing countries. Therefore, the ongoing research into improving personalized and monitored therapy as well as the R&D of novel drugs to improve the e caciousness of therapy is well warranted. (N. Loh)

References

1) HansN. Staphylococcus aureus and discovery of penicillin. Alexander Fleming and discovery of penicillin. How many lives has penicillin saved? http://www.bacteriainphotos.com/Alexander_Fleming_and_penicillin.html. Accessed February 23, 2020.

2)Antibiotic resistance. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Accessed February 23, 2020.

3)French G. Clinical impact and relevance of antibiotic resistance. Advanced Drug Delivery Reviews. 2005;57(10):1514-1527. doi:10.1016/j.addr.2005.04.005 4)Zaman K. Tuberculosis: a global health problem. J Health Popul Nutr. 2010;28(2):111–113. doi:10.3329/jhpn.v28i2.4879 5)Harvard Health Publishing. (2019, January). Tuberculosis. Retrieved February 23, 2020, from https://www.health.harvard.edu/a_to_z/tuberculosis-a-to-z

6)LoBue PA, Mermin JH. Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA. Lancet Infect Dis. 2017;17(10):e327–e333. doi:10.1016/S1473-3099(17)30248-7 7) Iseman M. Tuberculosis (TB). National Jewish Health. https://www.nationaljewish.org/conditions/tuberculosis-tb. Published February 1, 2013. Accessed February 24, 2020.

8)PatientCareLink. (n.d.). Healthcare-Acquired Infections (HAIs). https://patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais/ 9)PatientCareLink. (n.d.). Healthcare-Acquired Infections (HAIs). https://patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais/ 10) Niger Med J. (2012, April). Healthcare – associated infections: A public health problem. doi: 10.4103/0300-1652.103543

Mental Health Crisis Preventions and Cares Spring 2020 BSPS students: Hongyu Su, Soyeon Lee, Ziqi Guo, Tianyun Zhang Purdue University, College of Pharmacy

Introduction Mental health illness is defined as a mental, behavioral, or emotional disorder. The symptoms or impact could vary from no impairment to serious functional impairment in which considerably disrupting one's physical and daily activities, such as working, sleeping, and feeling. Researchers have shown that mental health illnesses are common, and becoming increasingly important in the United States, with the fact proving that Mental illnesses are affecting tens of millions of people each year, but only around half of the affected individuals received appropriate mental health care, and those who did not receive mental health supports are more likely to end up in disability, secondary health problems, and, if the worse case, suicide attempts. In this poster, we will cover four subtopics, which are alcoholism, eating disorder, discrimination, and healthcare supports. Our first objective is to prevent mental illnesses by introducing the health effects of the two most common diseases, alcoholism, and eating disorders. Secondly, we will cover potential mental health support resources for individuals who substantially suffered from mental and emotional disorders to minimize mental health illness exacerbation.

Alcoholism

Alcoholism: individuals have strong needs for alcohol consumptions Alcohol dependence: Diaphoresis, shakiness, nausea and anxiety after withdrawn.

Figure 1. Death rates, by age and sex: United States, 1955–2017, Rates are based on population estimates which differ from infant mortality rates (based on live births); SOURCE: NCHS, National Vital Statistics System, Mortality. Source: https://www.cdc.gov/nchs/fastats/alcohol.htm

The US Statistics: 14.4million adults (9.2million men/5.3 million women) and 401,000 adolescents are affected, high mortality rate in elder population.

Treatments: Disulfiram, inhibiting Acetaldehyde Dehydrogenase, creates an unpleasant effect after alcohol consumption; Acamprosate, a GABA agonist, helps to reduce alcohol intake; Also group/family therapy are available where patients talk to a therapist to reflect/check on their recent alcohol activities :) H. Su’s opinions: we should reinforce general medical knowledge to all people to make them aware of the downsides of heavy/under-age drinking. Also, I stay positive for current massive brain and drug researches. The more we study, the more questions we will ask. I believe someday soon, we shall overcome alcoholism with advanced medical knowledge and technologies.

Eating disorder Eating disorders are abnormal behavior involving food, due to mental conditions. About 30 million people in the US struggle with eating disorder and it can affect anyone regardless of gender, age, ethnicity or culture. The two most common types of eating disorders are Anorexia Nervosa and Bulimia Figure 2. Eating Disorders in America. Source: Nervosa. These disorders are much more common in https://www.thenortherner.com/news/2019/01/21/suffering-and-silenced-thereality-of-eating-disorders-on-campus/ women, especially teenage girls, with about 95% of people with anorexia and 80% of people with bulimia are female.

Patients with Anorexia Nervosa typically weighs less than the normal body weight, often believing that they are overweight. There are two types of Anorexia Nervosa, one being the restricting type where people reduce the amount of food they eat in order to lose weight. Another form of the disorder is binge eating and purging type, where they eat large amounts of food in one sitting and intentionally vomits or take laxatives.

Bulimia nervosa also involves this behavior, similar to the Anorexia Nervosa, but the difference is that the BMI of Anorexia Nervosa patients are very low whereas the BMI of Bulimia Nervosa is normal or higher than average. In both of these eating disorders, patients are preoccupied with food, their physical appearance and how much they weigh. They may have low self-esteem due to their distorted self-image.

Treating an eating disorder generally involves a combination of psychological and nutritional counseling. These patients should be monitored and addressed the symptoms and medical consequences, and also psychological, interpersonal, and cultural forces that contribute to or maintain the eating disorder. Nutritional counseling

is also very important and educating the patients about nutritional needs so that the patients make the right choices of what they eat every day.

S. Lee’s opinion: People do not realize how eating disorders can impact not only the patients themselves but also families and friends. Also, the media impose pressure on women to be “skinny and beautiful”. I think it is important to educate young adults to have positive self- image to prevent them from possibly getting an eating disorder.

Discrimination Discrimination of people with mental disorder is a global issue which is still not adequately understood by the society, especially in low- and middle-income countries. Many patients live with the stigma, shame, exclusion from the family and society: direct discrimination from other people, unfair insurance schemes, employment inequity, lesser investment of health-care resources, human rights violation in mental health institutions, hospitals, and communities.

In the past decades, more and more countries launched some activities, policies and laws that promote the rights of people with mental disorders and provide them with legal protections to reduce stigma and discrimination. For example, a program which called Time Figure 3. Is this what we want? Source: to Change and targeted to reduce mental health https://www.who.int/docstore/world-health-day/w hd2001/images/CICR-chains.jpg -related stigma and discrimination by 5% by facilitating social contact between people with and without mental health problems and provide online resource on mental health and employment, was launched in England in 2009.

Z. Guo’s opinions: I think a correct recognition of mental disorders is the most important and first step to diminish discrimination. Just like physical diseases, mental diseases are real medical conditions, which are diagnosable and treatable. Therefore, no justification in ethics, science or society can exclude people with a mental illness from our communities.

Mental health care Mental health care is facing challenges in both high-income countries and low- and middle-income countries (LMICs). More than 85% of the world’s population live in the LMICs. More than 80% of people who have mental disorders are living in LMICs, with mental illness accounting for 8.8% of the total burden of disease. However, the proportions of people with severe mental Figure 4 Untreated individuals in America. Source: disorder who receive treatment are only 11.1% in China. On the https://mississippitoday.org/2019/09/30/mississippi-menta l-health-care-the-system-failed-bobby/ other hand, as a high-income country, the United States was proclaimed to have a mental health system as colossal failure. The high-income countries also have problems in mental health systems as too expensive, fragmented, and not focused enough. The challenges facing mental health services share in LMICs and high-income countries, including lack of appropriate legislation and policy, lack of funding, lack of evidence-based interventions and training, and lack of public education.

One evidence for current public education would be Mental Illness Awareness Week (MIAW), which was established in 1990 by the Congress. It is the first week in October every year. During this week, mental health organizations across the country fund events and provide mental health information to promote public education. Purdue has its own MIAW every February. It is held by Purdue Students Government and College of Pharmacy. During MIAW in 2020, Purdue held many interesting events including yoga, cycling, therapy dogs, and ask a pharmacist.

T. Zhang’s opinions: Public education is the most important goal we need to focus on right now. The current public education is mostly targeting people who want to know more about this area, but people who have not heard of mental illness at all is who we really want to help. .

References ●

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Alcohol Facts and Statistics. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-andstatistics. Published February 18, 2020. Accessed April 6, 2020.

Carr GD. Alcoholism: A Modern Look at an Ancient Illness. Primary Care: Clinics in Office Practice. 2011;38(1):9-21. doi:10.1016/j.pop.2010.11.002 Eating Disorders: About More Than Food. National Institute of Mental Health. http://nimh.nih.gov/health/publications/eating-disorders/index.shtml#pub1.

Published 2018. Accessed February 5, 2020.

Henderson C, Corker E, Lewis-Holmes E, et al. England's Time to Change Antistigma Campaign: One-Year Outcomes of Service User-Rated Experiences of Discrimination. Psychiatric Services. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201100422?url_ver=Z39.882003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed. Published May 1, 2012. Accessed February 23, 2020.

Jacob K, Sharan P, Mirza I, et al. Mental health systems in countries: where are we now? The Lancet. 2007;370(9592):1061-1077. doi:10.1016/s0140-6736(07)61241-0 Mental Illness Awareness Week. Mental Health America. https://www.mhanational.org/mental-illness-awareness-week. Accessed March 31, 2020.

Mental Illness Awareness Week. NAMI. https://www.nami.org/miaw/. Accessed March 31, 2020.

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Rathod S, Pinninti N, Irfan M, et al. Mental Health Service Provision in Lowand Middle-Income Countries. Health Services Insights.

2017;10:117863291769435. doi:10.1177/1178632917694350 Waltz N. Suffering and silenced: The reality of eating disorders on campus.

The Northerner. https://www.thenortherner.com/news/2019/01/21/suffering-and-silenced-the -reality-of-eating-disorders-on-campus/. Accessed April 6, 2020.

Watkins B, Mississippi Center for Investigative Reporting. Mississippi mental health care: 'The system failed Bobby'. Mississippi Today. https://mississippitoday.org/2019/09/30/mississippi-mental-health-care-thesystem-failed-bobby/. Published September 30, 2019. Accessed April 6, 2020.

World Health Organization. Is that what we want? https://www.who.int/docstore/world-health-day/whd2001/images/CICR-chai ns.jpg World Health Organization. Mental Health Around The World. https://www.who.int/world-health-day/previous/2001/files/whd2001_dare_to _care_en.pdf. Published 2001. Accessed February 23, 2020.

Diet

Dietary Supplements

Nutrition

What is it?

Diet is defined as “a special course of food to which one restricts oneself, either to lose weight or for medical reasons”1

SPRING 2020 Jungwon Park, BSPS student Heesoo Lim, BSPS student Sydney Williams, BSPS student

What are the trending areas?

“Fad” Diets Diets that promise quick results/weight loss, usually strictly time meals (intermittent fasting) or withhold certain food groups (keto diet).2 Tips for deciding if these diets are for you: ● make sure all key nutritional needs are met ○ consult an expert if there is uncertainty ○ see “Choose My Plate” image below for reference of nutritional goals ● avoid unrealistic lifestyle changes, such as long term fasting schedules ● avoid diets that promise weight loss without exercise, large weight loss short term, or other “too good to be true” type claims ● eating disorders and poor body image can encourage extreme dieting3 Vegan/Vegetarian Diet Vegan involves avoiding animal products, namely in diet Vegetarian involves avoiding the consumption of meat Substitutions are needed to ensure these individuals are consuming all necessary food groups. Diet has to be full of nutritional foods and proper substitutions are needed for categories such as proteins. If doing to lose weight, processed foods will need to be avoided like with any other diet.4 Value versus Cost of Food Healthy food has been proven to be more expensive. There is research proving the deficit between healthy, nutritional foods and “empty calorie” foods, like overly processed foods. There is also proof though that healthy eating mat be more expensive short term, but in the long term will save people money by reducing medical bills.5,6 Tips for eating healthy on a budget ● make a grocery list with all ingredients needed for the week’s meals ● look for coupons and enroll in discount/reward programs ● consider buying store brands over “name” brands ● look into foods like whole grains, vegetables and beans ○ possibility to make multiple servings for about $2 7,8,9

What are they?

Dietary supplements are any products that are taken orally that contain dietary ingredients, such as vitamins, amino acids, minerals, herbs or proteins.14 Dietary supplements can help people get certain nutrients that they lack or can’t acquire by eating food. Therefore, they can be extremely beneficial to your health when taking the appropriate supplement at the correct dose.

What’s the issue?

Nutrition is a crucial aspect of people’s lives and they need to consume proper nutrients to live a healthy life. However, with the trends in the current society, people around the world aren’t getting enough nutrients via consumption of various foods, but relying on the nutrients supplied by dietary supplements. In fact, according to CDC, only 12% of Americans consume the recommended amount of fruits and vegetables, 15 and this gap in nutrition intake is being filled by dietary supplements. This trend is spreading around the world, which can be observed by looking at the graph below. As the demand grows for the dietary supplements, the market size will grow and will continue to grow as the convenience of taking a pill outweigh the labor of purchasing or preparing different types of foods.

Introduction Nutrition can be defined as “the process by which living things receive the 1 food necessary for them to grow and be healthy”. As important nutrition is to people’s well being, there are problems that arise when nutrition is not being carefully considered. We have defined diet, malnutrition, and dietary supplements as some of the biggest problem areas of nutrition that can be found and affect people globally.

Lastly, the development and production of dietary supplements are not regulated by the FDA, and this may lead to production of tainted products. Currently, the FDA regulates dietary supplements under the Dietary Supplement Health and Education Act (DSHEA). This act, however, only requires the producers of dietary supplements to get their product reviewed, but not necessarily approved, by the FDA which may lead to problematic products. For example, a dietary supplement containing Acacia rigidula was found to contain a substance called β‐methylphenylethylamine (BMPEA), which was never studied.17 Because this substance lacks evidence of safety in humans, it may be unsafe for people to consume this product.

What is being or should be done?

- FDA and NIH are constantly conducting post market research on products currently on market to find any irregularities - People should be educated on the proper consumption of dietary supplements

Personal Opinion People need to be very careful when it comes to diets. Starting a diet that is unrealistic or has unreliable supporting data will cause discouragement, health issues, and can waste time and money. Diets need to be critically examined before starting to ensure they are realistic. It is also important to create food budgets to allow for healthy eating, both globally and nationally S. Williams

Another issue is that as people take these supplements, they unknowingly overdose themselves with it, causing them to experience an adverse event. According to a study by the New England Journal of Medicine, an average of 23,000 people visit the emergency room due to an adverse event caused by dietary supplements.16 This occurs mostly because people consume nutrients through meals, but without considering how much nutrients they have taken in through their meals, they take a fixed dose of the supplement, with which they may end up having too much of.

Personal Opinion Because consuming enough nutrients is crucial for one’s health, taking dietary supplements is great, just as long as people are careful and aware of what they are consuming. Supplements should be taken with a proper product at a safe dose in order for them to be truly beneficial to our health. Therefore, it would be best if people visit a doctor or nutritionist to discuss about their health and what kind and how much supplements they should take.

J. Park

Malnutrition & Food Assistance Programs What is malnutrition?

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients and concurrent ongoing global issue. 10

What are the following issues?

More than 3 millions of children die from malnutrition and about 3.9 billion of people have malnutrition which are almost a half of whole population. Malnutrition, as described in its definition, it does not only include undernutrition, but also overnutrition which is commonly referred as obesity.

Child malnutrition is total big issue in the 3rd world countries. Those children have same feature in common. Those are stunting(significantly below standard height for their age), underweight(significantly below standard weight for their age), wasting(significantly below standard height to weight ratios), and micronutrient deficiencies. Especially these children will face the cycle of hunger in their further life. They will meet difficulties in their education, relationships and biological reproduction. However, this is the only for those who survived from malnutrition. 11 Adult malnutrition is also big issue. This has been issued more in wealthy country since the obesity population is increasing with sufficient intake of food. But in also some relatively poor countries, the social isolation comes from aging causes adult malnutrition. By aging, they naturally have body dysfunction which can induce lower in appetite. Furthermore, isolation causes less access to food. 12

Child Malnutrition Rates, 2010.

What are food assistance programs? ● Nutritional treatment 13 ○ Dietary supplements ○ Ready-to-use therapeutic food(RUTF) ○ Genetically modified produce(GMP) ● Support from international organization ○ 2030 agenda from UN ■ Agricultural sustainability, education on nutrition, governmental support ● Education ○ something that has to be done in school as well as all communities spontaneously

Personal Opinion

Choose My Plate Nutrition Guide, 2020.7

“2019 - Hunger Map.” 2019 - Hunger Map | World Food Programme, www.wfp.org/publications/2019-hunger-map.

Intake of food itself is never difficult. Being aware of the people, recognizing the problems that they have and sharing what I have are also not difficult. Even though malnutrition, the imbalance, is no one's fault but I think this is everyone's responsibility. This is disease that each individuals can prevent with interest, concern and a bit of morality.

H. S. Lim

References 1.

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Oxfordlearnersdictionaries.com. 2020. Oxford Learner's Dictionaries | Find Definitions, Translations, And Grammar Explanations At Oxford Learner's Dictionaries. [online] Available at: <https://www.oxfordlearnersdictionaries.com/us/> [Accessed 31 March 2020].

What You Should Know About Popular Diets. Nutrition.gov. https://www.nutrition.gov/topics/healthy-weight/what-you-should-know-about-popular-diets. Accessed February 11, 2020.

8 “Fad” Diets That Actually Work. HealthlineMedia. https://www.healthline.com/nutrition/8-fad-diets-that-work. Accessed February 11, 2020 NHS Choices. https://www.nhs.uk/live-well/eat-well/vegetarian-and-vegan-diets-q-and-a/. Published August 2, 2018. Accessed February 11, 2020.

Prescribing healthy foods could bring cost-effective benefits. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/prescribing-healthy-foods-could-bring-cost-effective-benefits.

Published April 9, 2019. Accessed February 11, 2020.

Eating healthy vs. unhealthy diet costs about $1.50 more per day. News. https://www.hsph.harvard.edu/news/press-releases/healthy-vs-unhealthy-diet-costs-1-50-more/. Published January 13, 2014. Accessed February 11, 2020.

Healthy Eating On A Budget. ChooseMyPlate. https://www.choosemyplate.gov/eathealthy/budget. Accessed February 11, 2020.

10 Tips for Eating Healthy on a Budget. National Institute on Aging. https://www.nia.nih.gov/health/10-tips-eating-healthy-budget. Accessed February 11, 2020.

Magee E. Cheap and Healthy: 15 Nutritious Foods for About $2. WebMD. https://www.webmd.com/food-recipes/features/cheap-healthy-15-nutritious-foods-about-2-dollars#1. Published December 1, 2012. Accessed February 11, 2020.

What is malnutrition? (2017, February 6). Retrieved from https://www.who.int/features/qa/malnutrition/en/ Onis, M. D., & Blössner, M. (2003). The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. International Journal of Epidemiology, 32(4), 518–526. doi: 10.1093/ije/dyg099 Mangels, A. R. (n.d.). CE: Malnutrition in Older Adults : AJN The American Journal of Nursing. Retrieved from https://journals.lww.com/ajnonline/Fulltext/2018/03000/CE__Malnutrition_in_Older_Adults.23.aspx Whes. “World Child Hunger Facts.” World Hunger News, www.worldhunger.org/world-child-hunger-facts/.

Food and Drug Administration. FDA 101: Dietary Supplements. Available at: https://www.fda.gov/consumers/consumer-updates/fda-101-dietary-supplements. Accessed February 22, 2020.

Lee-Kwan SH, Moore L, Blanck H, Harris D, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption - United States, 2015. Morbidity and Mortality Weekly Report. 2017;66(45):1241–1247 Geller A, Shehab N, Weidle N, et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015;373:1531-1540. DOI:10.1056/NEJMsa1504267 Cohen P, Bloszies C, Yee C, Gerona R. An amphetamine isomer whose efficacy and safety in humans has never been studied, β‐methylphenylethylamine (BMPEA), is found in multiple dietary supplements. Drug Testing and Analysis. 2016;8(3-4):328-333.

Obesity

Alia Alailima (BSPS), Abby Martin (BSPS), Shiv Vithal (BSPS)

SPRING 2020

Obesity: is a condition in which there is excess fat accumulation. A BMI of 30 kg/m2 or higher is an indicator that one is obese. BMI stands for body mass index and it is calculated from an individuals height in meters and their weight in kilograms. According to the World Health Organization, 13% of the adult population in the world is obese. The prevalence of obesity has tripled across the world between 1975 and 2016.

Obesity & Diabetes: INFORMATION - Excess of accumulated fat (lipids) can lead to damage of organs and cells over a long time - Small percentages of weight loss (5% or greater) can lead to beneficial changes by lowering blood sugar levels and decreasing insulin resistance - Insulin resistance is when the body does not produce or use insulin as efficiently as it can - Is a progressive disease so blood sugar will get worse over time even with treatment. Either insulin or non-insulin type drugs can be used to treat patients, although non-insulin are preferred by the patient and used first but it depends

SCOPE/IMPACT A major independent risk factor for developing diabetes is obesity. More than 80% of patients with type 2 diabetes are obese/overweight. Obesity is a very common condition, especially in the US, as seen in the picture below.

OPINION: S. Vithal

https://global.rethinkobesity.com/science.html

I think that when people think about risk factors for diabetes they overlook the significance it has with obesity. Many people should be able to manage diabetes by being knowledgeable about their blood sugar levels and how it is affected by the various foods they eat. Even small changes to one’s diet over a long period of time can have a significant impact.

Obesity & Mental Health: INFORMATION/SCOPE - Studies procured from different areas proving a positive correlation between mental health and obesity - Generally, poor mental health coincides with the expression of factors leading to obesity (overeating, lack of motivation to exercise, poor nutrition, etc.)

SCOPE/IMPACT - No definite age range of impact - Mental health affects everyone differently at different times in their lives - Most affected are adolescents (high school/college) due to the stress of a rigorous academic system Actions Taken for Prevention - Counseling for overeating and mental health disorders - Health classes required to graduate (these classes are offered to high school students to teach and instill the regulation of a healthy, proportionate diet and regular exercise) - Free or discounted gyms on or near campus or schools OPINION: A. Alailima I believe that while mental health is not usually thought of as a determinant factor in obesity, although the correlation between the two are extremely evident. In fact, it can be one of the most influential factors in overeating and nutritional health. While different rules have been instilled to regulate the nutritional value of foods offered in schools, there should be more options offered towards the counseling of adolescents to prevent these issues. After all, the underlying problem should be treated in order to reduce the effect of the symptoms.

Obesity & Cancer:

References:

INFORMATION - Obese individuals have chronic low-level inflammation that overtime can cause DNA damage leading to cancer - Adipose tissue produces excess amounts of estrogen, excess fat tissue can lead to excess estrogen levels and increased cancer risk - Obese individuals often have higher blood levels of insulin and insulin growth factor-1 (IGF-1) - High levels of these two things promote development of many types of cancers - Fat cells produce adipokines- hormones that stimulate/inhibit cell growth SCOPE/IMPACT Obesity is a global issue with 13% of adults in the world being obese. It is especially an issue in America with nearly 40% of adults obese, effecting all the world.

OPINION: A. Martin I believe in today’s society the body shaming/image movement to accept your body has had many positive impacts on society, but has also allowed individuals who are obese and very unhealthy to feel that this is acceptable for their health. The movement pushes acceptance of where you are, but I think promotion of becoming a healthier version of you is very important. Being comfortable in your own skin is necessary for mental health, but as seen in the statistics shown in the figure to the right of cancer increase, physical health may suffer.

1) Kanter R, Caballero B. Global gender disparities in obesity: a review. American society for nutrition. 2012;3(4):491-8. doi: 10.3945/an.112.002063 2) Assari S. The link between mental health and obesity: role of individual and contextual factors. Int J Prev Med. 2014;5(3):247–249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018631/. Accessed Feb 16, 2020 3) McIntyre, R. S., Konarski, J. Z., Wilkins, K., Soczynska, J. K., & Kennedy, S. H. Obesity in bipolar disorder and major depressive disorder: results from a national community health Survey on mental health and well-being. The Canadian Journal of Psychiatry, 51(5), 274–280. https://doi.org/10.1177/070674370605100502 4) Franz, M. J., Boucher, J. L., Rutten-Ramos S., VanWormer J. J. Lifestyle weightloss intervention outcomes in overweight and obese adults with type 2 diabetes: A systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447-1463. https://doi.org/10.1016/j.jand.2015.02.031 5) Wolin, K. Y., Carson, C., Colditz, G. A. Obesity and Cancer. Epidemiology and Community Health, 15(6), 556-565. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227989/. Accessed Feb. 17, 2020

https://www.cancer.gov/about-cancer/causesprevention/risk/obesity/obesity-fact-sheet

Impact of Different Types of Pollution on the Human Health Burning Fossil Fuels (Corum), Fracking (Koh), Radiation (Varga)

Isaac D. Corum, Mei Koh, Tori Varga – Spring 2020 BSPS Students College of Pharmacy, Purdue University, West Lafayette, IN

Introduction

In the past several decades, humans have polluted the Earth in many ways often without the consideration of the long term effects on human health. There are many different forms of pollution that take place all over the world, but this poster will focus on three: burning fossil fuels, fracking, and radiation.

Fossil fuels such as coal, oil, and natural gas consist of hydrocarbons that have formed over millions of years from the remains of dead plants and animals. The burning of fossil fuels by humans is the largest source of emissions of greenhouse gasses that have negative impacts on the health of humans around the world. Air pollution from the burning of fossil fuels is a major health issue as it causes serious respiratory illnesses and various diseases. It has negative impacts on pregnancies, fetal mortality rates, and disability rates.

Hydraulic fracturing is a serious problem that is also a result of the search for energy, creating air and water pollution that has negative impacts on health in a similar pattern. Fracking uses up water in a world that is already undergoing a water scarcity crisis. It negatively affects respiratory, cardiovascular and reproductive health. The effects of fracking are wide reaching and permanent.

Radiation, or radioactive waste, are fast moving subatomic particles which causes the them to be split in half and become ionized, or charged. Radiation is used to generate energy around the world, but it can cause more harm than good. When nuclear power plants fail, water and aquatic life are harmed, plant growth is inhibited, and human illnesses and cancers are created. Human and environmental health are affected when radiation is released, and there are many examples of radiation disasters.

Burning Fossil Fuels

Fracking site

Fracking

Air pollution has really only been seriously prevalent in the world since the industrial revolution (1820-1840). In the past 200 years the world has produced significant amounts of greenhouse gasses that have since accumulated in our atmosphere, leading to health issues around the word.

Carbon dioxide (CO2) is the main greenhouse gas produced from the burning of fossil fuels. Different economic sectors produce more CO2 than others. The pie chart on the right (top) shows the percentage of greenhouse gas emissions per economic sector with electricity and heat production being the highest contributor and industrial processes being the second highest. The pie chart on the right (bottom) illustrates the countries responsible for the most air pollution with China being in first and the US being in second. China has double the amount of greenhouse gas emissions as compared to the US and produces the same amount as the entire world minus 5 countries.

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Fracking or hydraulic fracturing is a method used to [8] extract natural gas and oil from deep rock formations known as shale. Water, sand, and a mix of chemicals are forced into the horizontally drilled wells to crack the shale to release the gas or oil. This method poses many health risks to those around drilling sites, ranging from respiratory, cardiovascular, nervous, and reproductive problems.

Air Hydraulic fracturing has a heavy impact on air quality. This occurs primarily from the emissions released during drilling.

Engines used during well preparation, drilling and production is one problem.

Fine diesel soot particles lodge into the lungs from the diesel emissions of the engines. The effects of drilling on drill workers are similar to coal miners.

The burning of coal is linked to many major disease states in the US. High levels of CO2 in the air coupled with the particulates produced from the burning of coal and other fossil fuels has been associated with asthma, bronchitis, heart attack, heart disease, cancer, neurological defects, deficient immune systems, and organ damage. According to the Environmental Health Perspectives, particulates produced from coal burning are 5 times as harmful to the heart as compared to burning oil or natural gas. Additionally, burning coal releases mercury and lead, which are very harmful to the nervous and immune systems. According to the National Association for the Advancement of Colored People, roughly [5] 68% of African Americans live within 30 miles of a power plant that runs on coal. African American children are 3 times more likely to need to go to the emergency room and 2 times more likely to die from an asthma attack as compared to Caucasian children. Furthermore, Mexican people are 51 percent more likely to live in areas with higher rates of ground level ozone and their children have double the chance to die from asthma as compared to Caucasian kids. 10 people die every day in the world from asthma.

In study published in 1993, Dockery and his colleagues found that levels of particles smaller than 2.5 micrometers (PM-2.5) in the air in the most polluted cities in the Midwest were linked to a 26% increase in adult death rates from all causes compared to the least polluted city. In the same study with a different sample group, they analyzed approximately 4 million infants born between 1989 and 1991 in 86 different urban areas. After taking all necessary considerations, they found that the odds ratio for mortality in infants born in areas with high levels of particle sizes less than 10 micrometers (PM-10) compared to infants born in areas with low exposure to PM-10 was 1.1 to 1. In babies with normal birth weights, high exposure to PM-10 was linked with higher incidences of sudden infant death syndrome and mortality as a result of respiratory causes. The world health administration estimates air pollution accounts for: ❖ 29% of all deaths and disease from lung cancer ❖ 17% of all deaths and disease from acute lower respiratory infection ❖ 24% of all deaths from stroke ❖ 25% of all deaths and disease from ischemic heart disease ❖ 43% of all deaths and disease from chronic obstructive pulmonary disease

[9]

Radiation waste

Air pollution from an industrial power plant

Another problem that occurs from drilling are the volatile hydrocarbons and toxics released during drilling. Oil/gas formation contain hydrocarbons and other gases. Benzene, one toxic hydrocarbon, was found to be often higher than the minimum risk levels set by the CDC in a study by the West VA department of Environmental Protection. Another example is Hydrogen Sulfide, which is produced along with the hydrocarbons that damages the CNS. This can cause nervous system problems.

The sand (silica) used during fracking can also lead to silicosis, which is an irreversible lung disease.

NIOSH researchers collected 111 personal breathing zone samples at 11 sites in 5 states to discover that full-shift samples exceeded occupational health criteria, with some samples exceeding 10x more. This means that even with proper airpurifying respirators, protection is inadequate as it exceeds the masks’ max use concentration.

Water The 2005 Energy Policy Act exempts hydraulic fracturing from key provisions of the Safe Drinking Act through the “Halliburton loophole”. The oil and gas sector are permitted to inject known hazardous materials near or directly into underground drinking water aquifers, routine monitoring is not required and companies are not compelled to fully disclose identity of chemicals used in fracking. These chemicals used are extremely hazardous to human health. Of the more than 1,000 chemicals confirmed as ingredients in fracking fluid, an estimated 100 are known endocrine disruptors, or act as reproductive and developmental toxicants. Others are heavy metals, radioactive elements, brine, and volatile organic compounds. These toxic substances can leak into surrounding watersheds, streams and aquifers.

PA has determined that 343 private drinking water wells have been contaminated or otherwise as a result of drilling and fracking operations over an 8yr period. A 2017 study found that spills of fracking fluids and fracking wastewater are common, documenting 6,678 significant spills occurring over a period of nine years in four states alone. Between 2 and 16 percent of wells report spills each year in these 4 states. About 5 percent of all fracking waste is lost to spills, often during transport.

Personal Opinions It is clear that all three forms of pollution that we have covered in this poster have major impacts on human health around the world. Air pollution has correlation and causation to increased rates of various respiratory illnesses, cardiovascular illnesses, and others. If the world does not come together to make a global effort to end or significantly reduce the amount of burning of fossil fuels by converting to electric cars and other forms of renewable energy, the rates of death from these illnesses will only continue to increase. A larger transition to more renewable forms of energy would decrease usage of hydraulic fracturing and improve overall health. Much of the drive for fracking is due to energy companies seeking out nonrenewable resources such as oil and gases. If energy companies were made responsible for their drilling areas, fracking would be less dangerous. Radioactive energy has been around for a long period of time, but it has caused more harm than good. Environmental disasters have occurred such as Chernobyl, an uninhabitable area for thousands of years due to a radiation disaster.

Radiation

Radiation, or radioactive waste, are fast moving subatomic particles which causes the particles to be ionized, or charged. Radiation is used to generate power via nuclear power plants. The U.S. uses nuclear power plants to generate 20% of the country’s power. The power plants heat water to move big turbines via nuclear fission. The nuclear fission is what generates the radioactive particles. Radioactive waste can cause local and global pollution. Some examples include Chernobyl and Fukushima. These power plants are famous examples of the harm and destruction radiation may cause. Radiation has caused numerous cancers in persons near the nuclear disasters, and some environmental issues as well.

https://en.wikipedia.org/wiki/Radiati on_effects_from_the_Fukushima_Dai ichi_nuclear_disaster

Air Radioactive waste does not directly affect air quality, but it does affect the travel of radioactive particles. While radioactive particles are invisible to the naked eye, it is still able to travel. Radioactive particles are carried in the wind to other areas and affect many other persons. Radioactive particles causes cancer and genetic mutation in wildlife and humans. DNA replication is disrupted and accelerated leading to cancer. Genetic mutations can also be passed on to offspring, leading to illnesses and depletion of a species.

An example of a species affected by radiation are seals. Off the coast of Russia, the seal population was slowly decreasing. This is believed to be due to the over exposure of radiation from Chernobyl.

Water Radioactive particles can interact with water molecules and become ionized.

When water molecules become ionized, they may gain more molecular weight.

This causes the particles to sink to the bottom of an ocean, for example, and interact with seaweed. In this case, aquatic animals such as shrimp, crucians, and some fish will become radioactive as well. Other sea life will ingest the radioactive creatures, and so on. This affects sea life and even humans in the case of fishing.

After Fukushima, Yale’s School of Forestry and Environmental Studies measured ocean radiation levels were taken off the coast of Japan up to 100 miles away.

The water was shown to be contaminated many months later in 2011.

Land Plant life is not affected by radiation. Since plants can with stand UV radiation, they were able to with stand radioactive particles.

Seeds, however, are unable to sprout. New plant life cannot grow due to nitrogen, phosphorous, and other elements in soil become less nutrient rich. https://www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html

References

[1] The Localized Health Impacts of Fossil Fuels. Climate Nexus. https://climatenexus.org/climate-issues/health/the-localized-health-impacts-of-fossil-fuels/.

Published November 14, 2019. Accessed February 15, 2020.

[2] 10 Health Problems from Fossil Fuels. Arcadia. https://blog.arcadia.com/10-health-problems-fossil-fuels/. Published August 9, 2017. Accessed February 15, 2020.

[3] Grigg J. The health effects of fossil fuel derived particles. Archives of Disease in Childhood. 2002;86(2):79-83. doi:10.1136/adc.86.2.79.

[4] Global Greenhouse Gas Emissions Data. (2019, September 13). Retrieved March 26, 2020, from https://www.epa.gov/ghgemissions/global-greenhouse-gasemissions-data [5] Mendez, K. (2019, November 22). Asthma Capitals 2019: The Most Challenging Places to Live With Asthma. Retrieved March 26, 2020, from https://www.aafa.org/asthma-capitals/ [6] Mallard, S., Maise, E., DeGroot, L., & Park, J. (2019, August 19). Particulate pollution responsible for worldwide disease rates: study. Retrieved March 26, 2020, from https://www.gwhatchet.com/2019/08/18/particulate-pollution-responsible-for-worldwide-disease-rates-study/ [7] Bushkin-Bedient S, Dyrszka L, Gorby Y, et al. Compendium of Scientific, Medical, and Media Findings Demonstrating Risks and Harms of Fracking. Physicians for Social Responsibility. Available at: https://www.psr.org/wp-content/uploads/2019/06/compendium-6.pdf. Accessed February 11, 2020 [8] Hoffman J. Potential Health and Environmental Effects of Hydrofracking in the Williston Basin, Montana. National Science Foundation. Available at: https://serc .carleton .edu/NAGTWorkshops/health/casestudies /hydrofrackingw.html. Accessed February 12, 2020.

[9] Hydraulic Fracturing and Your Health: Air Contamination. Physicians for Social Responsibility. Available at: https://www.psr.org/wpcontent/uploads/2018/05/ fracking-and-air-pollution.pdf. Accessed February 11, 2020 [10] Marusic K. After a decade of research, here's what scientists know about the health impacts of fracking. Environmental Health Network. Available at: https://www.ehn.org/health-impacts-of-fracking-2634432607.html. Published November 18, 2019. Accessed February 12, 2020.

[11] Srebotnjak T, Rotkin-Ellman M. NRDC. Fracking Fumes: Air Pollution from Hydraulic Fracturing Threatens Public Health and Communities. Available at: https://www.nrdc.org/sites/default/files/fracking-air-pollution-IB.pdf. Accessed February 11, 2020

Rare Diseases and Disorders Mandy Everly, BSPS Student; Shauntielle James, BSPS Student; Amanda Waldbieser, BSPS Student

Spring 2020

Introduction

Treatment Accessibility

Advocacy and Education

In the United States, rare diseases are defined as diseases that affect fewer than 1 in 200,000 people. There are thought to be around 7,000 rare diseases known today, but more are being identified. Disease is not limited to a geographic location or cultural association, so rare diseases are a global issue.

Despite affecting a large portion of the population, there are still problems surrounding issues such as treatment availability, orphan drug development, and rare disease education and advocacy.

Treatment accessibility is one of the major issues when it comes to rare diseases. Around the time of the Orphan Drug Act, the FDA and National Institutes of Health federal programs encouraged product development and clinical research for products targeting rare diseases.

Ten years after the signing of the US Orphan Drug Act, rare diseases have been a research priority for the European Commission. This created incentives to provide patients suffering from rare diseases with medicinal products which are safe, effective, and produced according to the same quality standards as other products. Since implementation of the ODA, about 1,700 medicinal preparations have been designated as orphan products with about 300 being developed orphan drugs available on the market. The EuOrphan project, which consists of 5 European countries and 13 research institutions, provide a set of web-based services for the dissemination of information on the orphan drugs available worldwide.

EuOrphan provides four services: 1) international database containing up-to-date information about orphan medicines including prices and availability throughout Europe, 2) data and statistics on the orphan market at a worldwide level, 3) a consultancy service, and 4) a forum for the recruitment of patients for clinicals trials, organize interest groups, and stimulate new studies.

The affordability of treatments makes it difficult for patients to receive the care that they need. Treatment expenses for rare diseases are typically paid all at once, even though most treatments are received over many years. High costs of treatments put financial burdens on both the patient and payer, and with new treatments continuously being made, the financial burdens are expected to increase even more.

Despite being identified as rare diseases, it is estimated by the National Organization for Rare Disorders that around 30 million Americans (as many as 1 in 10) live with a rare disease or disorder. Although there are a significant number of individuals impacted by these conditions, it is a global issue that not much is known about rare diseases or disorders, which is mirrored in the fact that fewer than 10% of the 7,000 known diseases have FDA approved treatments. This emphasizes the unique role that advocacy and education play in informing the general public, as well as policymakers, about the key issues surrounding the topic in order to develop improved conditions for everyone affected by rare diseases and disorders.

Orphan Drugs A major issue with rare diseases is pharmaceutical companies are not investing as much research and development in treatments for these diseases.

An orphan drug is a drug that is underdeveloped due to limited potential for profitability for pharmaceutical companies. The US passed the Orphan Drug Act to try to encourage the development of these drugs by providing incentives for pharmaceutical companies, such as market exclusivity and reduction of procedural fees. While there have been many successes following this act and many new orphan drugs have entered the market, there are also several concerns.

Pharmaceutical companies could create a monopoly since they may be the only company providing a drug. The prices of orphan drugs can be extremely high because of this, as demonstrated by the figure below. In addition, it seems that companies are only focusing on developing treatments for diseases that could be the most profitable for the company. Research for other, lesser-known rare diseases is being neglected. This leads to questions of what should be considered a rare disease.

Personal Statement I believe that legislation needs to be passed to prevent pharmaceutical companies from increasing the price of orphan drugs. Many people are in desperate need of these drugs, but they cannot pay the high prices required for them. The graphic below shows just how expensive orphan drugs can be. I also think that a hierarchy of rare diseases should be established, and research for rare diseases with fewer cases should have more reward and incentive. This would prevent pharmaceutical companies from honing in on a select few diseases to obtain more of a profit. ~ A. Waldbieser

Roland D. The Price Dilemma Over a $16,000 Drug. The Wall Street Journal. https://www.wsj.com/articles/the-price-dilemma-over-a-16-000-drug-1499832421. Published July 12, 2017. Accessed March 31, 2020.

Even with such burdens, pharmaceutical companies have tried to make it easier on patientsâ&#x20AC;&#x2122; payment plans. Pharmaceutical companies can create value-based contracts that permit payment for therapies over several years. These contracts ensure that the payers are not financially responsible for treatment failures. A bill was also introduced for pharmaceutical and medical device companies to create payment installment deals with insurers linked to the performance of their products. Clinical pathways are usually used to identify the right treatment but there is also opportunity to use pathways to provide guidance on the right payment approach. Another solution would be for manufacturers to partner with financial institutes that provide patients with long term loans for treatments. Other general payment pathways are Medicare, federal reinsurance and subsidies, and reference pricing. However, payment still remains largely unanswered.

NORD. National Organization for Rare Disorders. https://rarediseases.org/. Accessed February 16, 2020.

The National Organization for Rare Disorders (NORD) is one of the key groups that supports education on rare disease issues. They provide resources and information that allow everyone to be involved in some way with rare disease education. One of their biggest projects and campaigns is Rare Disease Day, an international event held on the last day of February that coordinates to raise awareness though numerous activities and projects meant to engage the general public. Each of the 100+ nations that participate aim to target the education of the general public, as well as gain support from policymakers.

Various events are held, such as conferences, concerts, family nights, races, and sports events. The purpose is to create equity within the rare disease population as they aim for social inclusion and universal healthcare coverage. They also supply advocacy resources for those wanting to take a more active role, provided through the Rare Action Network (a subset of NORD). Here individuals can connect with others wanting a role in advocacy by finding advocacy issue resources, patient stories, events, and other ways to take action.

Groups such as NORD help to drastically minimize and raise awareness for the negative impact that rare diseases and disorders can have on those affected by them, in hopes of one day eliminating them through social inclusion and action.

Personal Statement I believe the work being done by organizations such as NORD is vital for the wellbeing of the rare disease community. I personally was not aware of how little was known, especially scientifically, about the cause and treatment of these conditions. Through participation in events that NORD and similar groups conduct, significant work can be done if everyone were to participate in some way. I think it would be particularly useful for college students to become involved, for we are a large student body with many voices, and we can help to be the voice of change for an underrepresented group. ~ M. Everly

Personal Statement

Express Scripts. (2017). Highest orphan drug prices [Infographic]. khn.org. https://khn.org/news/sky-high-prices-for-orphan-drugs-slam-american-families-and-insurhttps://khn.org/news/sky-high-prices-for-orphan-d rugs-slam-american-familiesand-insurers/ers/

I believe that it is important to provide patients with as much information there is on rare disease treatments to make the process less stressful. When patients have information on how or where to get treatment, it makes it easier for them to take the next step on assessing payment. I understand both sides when it comes to the burdens of patients and payers because patients usually need these treatments to survive but payers also spend a lot of money to make these drugs and have to profit from them. Therefore, finding a balance can help both payers and patients benefit. ~ S. James

References 1.) Genetic and Rare Diseases Information Center. U.S. Department of Health and Human Services. https://rarediseases.info.nih.gov/. Accessed February 16, 2020.

2.) J Ethics. 2015;17(8):776-779. doi: 10.1001/journalofethics.2015.17.8.pfor2-1508. Accessed February 13, 2020.

3.) NORD. National Organization for Rare Disorders. https://rarediseases.org/. Accessed February 16, 2020.

4.) Pakizegee, M. and Stefanacci, R. G. Pathways for Paying for Rare Disease Treatments. Journal of Clinical Pathways.

2019;5(1):e1-e3. doi:10.25270/jcp.2019.02.00057. Accessed February 14, 2020.

5.) Rare Action Network. Rare Action Network. https://rareaction.org/. Accessed February 16, 2020.

6.) Stakisaitis D, Spokiene I, Juskevicius J, Valuckas KP, Baiardi P. Access to information supporting availability of medicines for patients suffering from rare diseases looking for possible treatments: the EuOrphan Service.

PubMed.gov. https://www.ncbi.nlm.nih.gov/pubmed/17637514. Medicina (Kaunas). 2007;43(6):441â&#x20AC;&#x201C;446.

Accessed February 16, 2020.

Women’s Reproductive Health Spring 2020

Haylie Lohmar, PharmD Student, Ana Hernandez, PharmD Student, Esther Park, BSPS Student, Catera Hamilton, PharmD & BSPS Student

Globally women and girls, especially those living in poverty, lack access to adequate information, guidance, and services regarding their reproductive health.

Introduction

Access

“Women all around the world undergo a very important and difficult physiological process that prepares their body for the miracle of conception. Women should be able to embrace menstruation and be comfortable when seeking care and understanding. It is time to break stigmas and target the present lack of access in order to effectively receive proper care.” - Ana Hernandez

Stigma and taboos around women’s health remain pervasive in most societies. These effects have have serious negative consequences on women. For example, taboo around menstruation can prevent access to hygiene products, prevent partaking in school and sport activities and increases the risk of infection. Stigma around reproductive health can and is leading to a lack of maternal healthcare services and patients in the LGBTQ community have an increasingly difficult time finding supportive healthcare. Period shame has negative mental effects as well; it disempowers women by causing them to feel ashamed about a normal biological process.

While we have not discussed every topic surrounding women’s reproductive health, we have chosen a few broad topics to provide a general understanding. We understand these topics and those left out can be difficult to understand and discuss for some people, but in an effort to break down barriers and provide education from a healthcare perspective we have chosen to focus on the following topics.

It is crucial to have discussions about menstruation and how it is a developmental milestone and a important health sign. As healthcare providers we must equip adolescent girls and their key support group/influencers with the knowledge they need to manage their periods comfortably and with confidence. We must advocate for unrepresented issues like these that affect the daily lives of women. For example, more than 800 women die daily from preventable causes related to pregnancy and childbirth. We can make a difference!

Issue: On any given day, more than 800 million women and girls are menstruating -- yet menstrual hygiene and health is a neglected development and health issue. Taboos, stigma, and ignorance about periods harm girls everyday. There is a lack of access to menstrual products (tampons, menstrual pads), hygiene products, medications, and information. It is a global sanitation issue affecting many people around the world. The cultural shame that comes along with menstruation and resource shortage stop women from living normal lives like going to school and working.

According to UNICEF, poor menstrual hygiene cause many physical health risks linked to reproductive and urinary tract infections.

Who is affected: It is a global sanitation issue that affects many people - globally around 2 billion people live without sanitation services - according to UNICEF ONLY 27% of people in developing countries have adequate hand washing facilities at home. Young boys are also affected by this issue; educating boys and girls at an early age at school and at home promotes healthy habits and breaks that societal stigma. There is also a cultural shame that comes with menstruation in many places stop them from talking about period management to prevent complications like infections.

For example, in Nepal menstruating women as seen as dirty/impure by their communities and are banished to huts during their cycles. Also, a study conducted in Uganda found that many young girls skipped school while menstruating to avoid teasing by classmates.

Efforts/solutions: Current solutions focus on providing access to affordable and safe products; a handful of US states have passed laws that mandate schools to provide period products to students. The Department of Education and the MINA foundation called on the government to treat period product as health necessities - to help them stay in school. These efforts have helped fund products in bathrooms to protect students. On the global level, the WSSCC is working towards improvements in sanitation/hygiene in vulnerable communities. This certain organization aims to stop the menstruation stigma and change the policy through education/behavior change with some interesting intensives like having menstrual waste workshops, and promoting toilet designs that wandle waste (India).

Education “Misinformation is potentailly more dangerous than malpractice” -Esther Park

Who is affected: Menstruation- Girls at a young age should receive information about their menstruation, sex education, menopause, etc. Taboos and stigmas surrounding women’s reproductive health may hinder girls from an all encompassing Maternal Mortality Rates discussion. Unaddressed myths and misinformation can cause irreversible harm or consequences to undereducated girls.

Menopause- Women approaching menopause have a specific set of symptoms and potential ailments different than those previously experienced. Treatment and precautions, as well as general knowledge about their conditions are typically relayed by their primary health care providers. Those unable to afford or attend annual check ups and maintain contact with such healthcare providers miss this crucial information.

Pregnancy- Pregnant women require proper education and information for both their and their baby’s health. Studies have shown the benefits of prenatal education and the dire need for such to reach broader audiences. A study shows that in Bangladesh, preconceived notions and traditional practices for pregnant women thought to be healthful for the babies were actually detrimental to the health of their unborn children.

Contraceptives- Women between these age groups must still be looking out for their own reproductive health. A study conducted regarding women’s preferred contraceptives in comparison to their currently used contraceptives showed a large misalignment. These disparities spanned categories including cost and coverage, need, and method. By understanding options and one’s own health, women can make educated decisions to suit what is best for them.

Efforts/Solutions: Research shows that women are interested and invested in their own reproductive health; in fact, they recognize how impactful it may be to their general well being. Women were found to have preference for their reproductive health care providers for non-reproductive care, including primary care and mental health. Quality and trustworthy independent research can be conducted through credible sources, such as the CDC’s page on women’s health.

Sexually Transmitted Infections https://en.wikipedia.org/wiki/Reproductive_health#/m edia/File:Maternal_mortality_rate_worldwide.jpg

Issue: Women’s reproductive health is not a “one size fits all” issue. Each woman has different reproductive needs, cycles, and symptoms; advice for one is rarely relevant to the whole population. Understanding how to sift through what advice is best suited to each individual begins with understanding educating the masses. In developing countries, a study found that 60% of women were dissatisfied with the amount of prenatal care information that was given during consultations at primary health care centers. Studies also show a positive correlation between delivery mortality and lack of knowledge of delivery risks and danger signs.

“STIs can affect anyone, as healthcare providers it is our responsibility to remove stigma and offer treatment and prevention for all patients. These infections are curable and we need to cure the patients.” - Haylie L

Issue: There are more than 30 infections that can be transmitted sexually, the majority of estimates are based on four curable STIs: chlamydia, gonorrhea, trichomoniasis and syphilis. The WHO estimates the global and regional prevalence from literature reviews every 5 years. In 2016 it was estimated 376 million new infections were reported of the four curables STIs. However, these estimates may not be accurate because fewer prevalence studies are being funded in representative populations to provide robust data. Additionally, data from 2016 estimated 417 million cases of herpes simplex virus and 291 million women infected with HPV. Who is affected: Anyone can be infected with an STI, young people and gay and bisexual men are at greatest risk. Young women will face the most serious long-term health consequences from an STI. In 2018, the US reported 2.4 million STI (1.8 million in 2013), half of the STIs are among the youth.

Efforts/solutions: WHO Goals for 2030 ●<50 cases of congenital syphilis per 100,000 live births in 80% of countries ●90% reduction in T. pallidum incidence globally ●90% reduction in N. gonorrhoeae incidence globally ●90% national vaccination coverage and at least 80% district coverage in countries with HPV vaccine in their national immunization programme.

Pregnancy “The emphasis must be not on the right to abortion but on the right to privacy and reproductive control.” - Ruth Bader Ginsburg Background Pregnancy and the birth of a child are big milestones for women across the world, however, this can be a very stressful time for a lot of women for a variety of reasons, especially women wish to opt out of the pregnancy. There are many reasons as to why a woman may not chose to continue, including saving their own life, preserving their own health, broad social or economic grounds and personal choice.

We believe there is still a stigma surrounding women who become pregnant and choose to have an abortion, regardless of reason for this procedure or marital status.

Issue: 970 million women, representing 59% of women of reproductive age, live in countries that broadly allow abortion and 41% live under restrictive laws. These legal restrictions on abortion do not result in fewer abortions. This leads to women risking their lives and health by seeking out unsafe abortion care.

Who is affected:This issue affects 700 million women of reproductive age. According to the World Health Organization, 23,000 women die of unsafe abortion each year and many more experience significant health complications due to improper medical care during this time.

Efforts/solutions: In the U.S., Planned Parenthood is a great resource for information and access to proper care, for prevention, pregnancy and abortions, as well as other topics relating to reproductive health. Over the past several decades globally, nearly 50 countries liberalized their abortion laws so that more women have access.

Moving forward: Currently, there’s a lot of controversy around this topic, not just in the U.S., but globally and we can expect more developments in the future. There should be more education for women about what their options are (varying depending on the country), the risks of unsafe abortions and overall reproductive health.

References 1.Global Fund for Women: Champions for Equality.. Sexual and Reproductive Health and Rights. Available at:https://www.globalfundforwomen.org/sexual-reproductive-health-rights/. Accessed on 2/13/2020 2.He K, Dalton VK, Zochowski MK, Hall KS. Women's Contraceptive Preference-Use Mismatch. J Womens Health (Larchmt).

2017;26(6):692–701. doi:10.1089/jwh.2016.5807 3.Hall KS, Harris LH, Dalton VK. Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers. Women's Health Issues. 2017;27(2):196–205. doi:10.1016/j.whi.2016.09.014 4.Al-Ateeq MA, Al-Rusaiess AA. Health education during antenatal care: the need for more. Int J Womens Health. 2015;7:239–242.

Published 2015 Feb 18. doi:10.2147/IJWH.S75164 5.Sanchez E, Rodriguez L. Global Citizen. Period Poverty: Everything You Need to Know. Available at: https://www.globalcitizen.org/en/content/period-poverty-everything-you-need-to-know/ Accessed February 17, 2020.

6.Scaccia A. Free The Tampons. The Price Young Girls Pay When Tampons Aren’t Free. Available at: https://www.freethetampons.org/the-price-young-girls-pay-when-tampons-arent-free.html Assesed February 17, 2020.

7.Monteleone P, Mascagni G, Giannini A, et al. Symptoms of Menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4): 199-215. DOI:10.1038/nrendo.2017.180.

8.Direkvand-Moghadam A, Sayehmiri K, Delpisheh A, et al. Epidemiology of premenstrual syndrome (PMS) - a systematic review and meta-analysis study. JCDR. 2014; 8(2): 106-9. DOI: 10.7860/JCDR/2014/8024.4021.

9.U.S. Department of Health and Human Services. Premenstrual syndrome (PMS). Available at: https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome. Accessed on Feb 4, 2020.

10.U.S. Department of Health and Human Services. Endometriosis. Available at: https://www.womenshealth.gov/a-z-topics/endometriosis.

Accessed on Feb 4, 2020. a.Background information and other data surrounding endometriosis is the United States is provided.

11.Centers for disease control and prevention. PCOS (polycystic ovary syndrome) and diabetes. Available at: https://www.cdc.gov/diabetes/basics/pcos.html. Accessed on Feb 4, 2020.

12.Newman L, Rowley J, Vander Hoorn S, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systemic review and global reporting. 2015; PLoS ONE 10(2). DOI: 10.1371/journal.pone.0143304 13.Narasimhan M, Pedersen H, Ogilvie G, et al. The case for integrated human papillomavirus vaccine and HIV prevention with broader sexual and reproductive health and rights services for adolescent girls and young women. 2017 Trans R Soc Trop Med Hyg 111(4) 141-3.

DOI:10.1093/trstmh/trx032.

14.Center for Reproductive Rights. (n.d.). The World's Abortion Laws. Retrieved March 31, 2020, from https://reproductiverights.org/worldabortionlaws?category[294]=294 15.Parenthood, P. (n.d.). Official Site. Retrieved from https://www.plannedparenthood.org/

In the US The US Department of Health and Human Services is working with respective parties to to develop a STI Federal Action Plan for STI prevention, diagnosis, treatment and care to improve outcomes.

The STI Federal Action Plan is set to be released in 2020.

Moving forward: Public health communities need to ensure effective prevention, screening, diagnosis and treatment interventions are more widely available. Public education on these efforts as well as removing any stigma should be reinforced.

https://communitiesfordevelopment.org/hot-in-the-valley-this-month-purses-handbags-and-reusable-sanitary-pads/